PacificSource Health Plans

  • Risk Adjustment Coding Specialist

    Job Location US-OR-Bend
    Job ID
    2018-269B
    Type
    Regular Full-Time
    Hiring Pay Range
    $22.00 - $26.00 per hour
    # of Openings
    1
    Status
    Non-Exempt
  • Overview

    This position supports enterprise risk adjustment through provider engagement and education.  The position will play a key role in helping the leadership team in setting strategic directions and priorities.

    Responsibilities

    1. Code all assigned medical groups and facilities to validate correct ICD coding by set deadlines.
    2. Maintain a coding accuracy of 95% or higher.
    3. Understand, interpret and deliver Hierarchical Condition Categories (HCC) coding risk adjustment audit results to provider groups.
    4. Ability to successfully perform other coding audits  to validate correct coding, which include, but isn’t limited to, CPT and HCPCS coding.
    5. Communicate with provider offices and their staffs, PacificSource Provider Network, and Revenue team.
    6. Provide ongoing education and feedback to physicians to obtain optimal documentation to meet coding and compliance standards.
    7. Assist in obtaining patient records from provider Electronic Health Record (EHR) systems.
    8. Assist in obtaining remote EHR access for our chart review vendors and internal PacificSource teams.
    9. Visit provider groups for on-site service calls to update office staff on administrative and claims procedures, and current coding issues.
    10. Other duties as assigned. 

    Supporting Responsibilities:

    1. Participate in provider specific and public presentations such as provider educational seminars on proper coding practices.
    2. Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
    3. Participate in local medical organizations such the local chapter of the American Academy of Professional Coders (AAPC).
    4. Complete other projects and duties as needed and assigned.

    Qualifications

    Work Experience: Three or more years of coding experience and demonstrated knowledge of CMS rules regulations and current coding resources, including EM, CPT, ICD-10 HCPCS, fee schedule and hierarchical condition categories (HCCs).

     

    Education, Certificates, Licenses: Bachelor’s Degree or equivalent experience in related field preferred. CPC certification required, coding experience in IPPS and OPPS preferred.

     

    Competencies

    Our Values

    • Adaptability
    • Building Customer Loyalty
    • Building Strategic Work Relationships
    • Building Trust
    • Continuous Improvement
    • Work Standards
    • Contributing to Team Success
    • Planning and Organizing
    • We are committed to doing the right thing.
    • We are one team working toward a common goal.  
    • We are each responsible for our customers'
    • experience.
    • We practice open communication at all        levels of the company to foster individual, team and company growth.
    • We actively participate in efforts to improve our many communities-internal and external.
    • We encourage creativity, innovation, continuous improvement, and the pursuit of excellence.

      

    Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 50% of the time.

     

    Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

     

    Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.

     

    PacificSource is an equal opportunity employer.  All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

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