Analyst, Risk Adjustment Coding

Risk Adjustment Coding Analyst 

The Risk Adjustment Coding Analyst is responsible for supporting the Strive clinical team and partner Nephrologists by providing risk adjustment education and clinical documentation support. The Risk Adjustment Coding Analyst is responsible for supporting the growth and improvement of Strive’s risk adjustment capabilities by conducting training, education, and management of coding and documentation improvement program. The Risk Adjustment Coding Analyst ensures technical aspects of diagnostic and procedure coding follow CMS, NCQA, third party payers and other regulatory agencies. They will monitor assigned provider's documentation and coding, educate assigned providers on CMS, AMA and Strive documentation and coding guidelines, educate assigned ongoing education of ICD-10-CM to the providers and Perform provider queries and addendum requests based on CMA, AMA documentation and coding guidelines The Risk Adjustment Coding Analyst will provide ongoing feedback and education to the clinical management team regarding accurate documentation to improve overall health outcomes for patients and continuity of care. 

Essential Functions 

• Delivers value to Strive and its beneficiaries enrolled in Risk Adjusted government programs (MA, ACO, ACA, CKCC), using skills including but not limited to: HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, and RADV Audits 
• Works closely with physicians, team members, quality, and compliance partners at enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding 
• Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories 
• Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements 
• Perform HCC coding on projects for MA, ACA, and ESRD. Ability to quickly flex between coding projects, including retro and prospective, with different MA, ESRD, and ACA HCC Models 
• Ability to work independently in various coding applications and electronic medical record systems to support departmental goals 
• Adheres to CMS Guidelines for Coding and Strive’s Policy and Procedures to guide HCC coding decision making 
• Assist with regulatory audits by performing first coding review and ranking of charts 
• Build partnerships and work within coding teams and internal partners critical to HCC coding including RCM 
• Participate on ad-hoc projects per the direction of leadership to address the needs of the department 
• Provide recommendations for process improvements and efficiencies 
• This individual will work in a matrixed organization to deliver complex ideas, support various key stakeholders, and assist with executing new risk adjustment initiatives 
• Using primarily the HCC Risk Adjustment model, conduct training with individual and large provider groups 
• Educate providers on the purpose of risk adjustment, as well as detailed and current risk adjustment documentation and coding training 
• Execute on risk adjustment onboarding training plans with new providers in the market 
• Analyze key coding performance indicators to determine those providers in need of initial or additional training 
• Identify training priorities and proactively schedule provider trainings with provider’s offices, individual providers, and groups of providers 

Minimum Qualifications 

• Active, CPC and CRC (Certified Risk Adjustment Coder) License  
• 2+ years of experience in out-patient risk adjustment coding, documentation, reporting, and auditing in a healthcare or managed care environment 

Preferred Qualifications 

• The ideal candidate is an expert in coding and documentation guidelines, knows how to develop strong relationships with clinicians, and is an effective, strong communicator 
• Use a customer focused approach in dealing with conflict and resolution of problems 
• Successful candidates will also have extensive presentation experience in the following areas: ICD-10-CM, CPT and HCPCS 
• Five years’ experience using ICD-10-CM, two years’ experience with risk adjustment training geared toward physicians 
• Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes 
• Expert knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance 
• MS Office Suite, Electronic Medical Records, Encoder, other software programs and internet-based applications as 
• Strong clinical assessment and critical thinking skills 
• Excellent verbal and written communication skills 
• Ability to work in a team environment. 
• Flexibility and strong organizational skills needed 

Annual Salary Range: $66,000.00-$77,000.00