SCOPE OF ROLE

The Bright Health Risk Adjustment and Coding Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. As a Coding Coordinator you will act as a primary coding contact for compliance oversight with a focus on accuracy and potential coding opportunities. The coding coordinator will also be responsible for secondary level quality audits.

ROLE RESPONSIBILITIES

• Participate in risk adjustment coding audits including but not limited to vendor bi-directional chart chases, gap closure, and coding completeness
• Play a key role in medical records retrieval; including but not limited to calling provider offices, obtaining medical records from EMR systems, and partnering with market nurses for retrieval
• Participate in secondary level quality audits of vendor’s work for RADV audits and other risk adjustment projects
• Responsible for performing code abstraction and/or coding quality audits of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation
• Identifies and tracks areas for documentation improvements and participates in documentation improvement initiatives
• Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines
• Meet and maintain coding quality and productivity standards
• Ensure compliance with all federal rules and regulations
• Research and respond to coding questions submitted via the coding inbox

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Required:
  • Associate degree or Bachelor’s degree required
  • Three (3) or more years’ experience in Medicare Advantage and Commercial coding and risk adjustment
  • Current coding certification through AAPC or AHIMA
  • Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines
  • Extensive knowledge of Medicare Advantage and Commercial HCC models
  • Proficient in Microsoft Office Products; Word, Excel, Powerpoint 
• Preferred:
  • Medical record retrieval experience
  • Certified Risk Adjustment Coder (CRC)
  • HHS IVA RADV experience

PROFESSIONAL COMPETENCIES

• Strong written and verbal communication skills
• Strong attention to detail
• Vast knowledge of EMR systems, medical record review and abstraction
• Ability to quickly learn and adapt to meet business needs
• Experience working with Risk Adjustment vendors
• Ability to work independently
• Ability to build relationships with office staff, physicians, and market team

LICENSURES AND CERTIFICATIONS

• Current coding certification through AAPC or AHIMA
• Certified Risk Adjustment Coder (CRC) preferred