Sr. Coding Coordinator

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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.

What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.

If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.


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 Senior Coding Coordinator, you will act as a primary coding contact for compliance oversight with a focus on coding and documentation accuracy and identifying potential coding opportunities. The Senior Coding Coordinator will also be responsible for secondary level quality reviews of vendor and peer quality reviews.

ROLE RESPONSIBILITIES

1. Lead risk adjustment coding reviews including but not limited to vendor bi-directional chart reviews, gap closure, and medical record review for documentation / coding completeness
2. Identifies and tracks areas for documentation improvements and participates in developing documentation improvement initiatives
3. Lead secondary level quality reviews of vendor work for RADV audits and other risk adjustment projects
4. Responsible for performing code abstraction and/or coding quality review of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation
5. Perform Peer Quality Reviews and provide feedback on results, including collaborating with leaders to develop educational tools
6. Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines
7. Meet and maintain coding quality and productivity standards
8. Ensure compliance with all federal rules and regulations
9. Research and respond to coding questions submitted via the coding inbox

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
Required
• Associate degree or Bachelor’s degree required
• Five (5) or more years’ experience in Medicare Advantage and Commercial risk adjustment coding
• Eight (8) or more years’ experience in ICD-10-CM
• 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
• Certified Risk Adjustment Coder (CRC)
• HHS IVA RADV experience
• Risk Adjustment auditing experience
• Medical record retrieval experience

PROFESSIONAL COMPETENCIES
• Excellent written and verbal communication skills
• Strong attention to detail
• Ability to lead coding review projects and provide feedback to coding staff
• 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

WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.

 

We’re Making Healthcare Right. Together.

We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:

 

Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.

 

Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.

 

Powered by Technology

We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.

 

          

 

As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 


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Location

We are downtown at 515 Congress Avenue, right in the heart of downtown! Tons of restaurants and close to public transportation.

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