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Certified Coder (Full-time) – Quality Risk Adjustment (Boulder, CO)

Boulder Medical Center

This is a Contract position in Boulder, CO posted May 17, 2022.

Job Description
Do you enjoy working with friendly and helpful people in a positive work environment? Are you ready to embrace a career that offers a variety of learning opportunities? Are you looking to make a positive impact on peoples’ lives in our community?

Consider a career at Boulder Medical Center (BMC). We’re an independent, multi-specialty, outpatient network of providers and staff dedicated to engaging our patients in high-quality, compassionate health care. For over 70 years, BMC has been locally owned and operated, providing exceptional medical care to patients across the northwestern Front Range and surrounding communities. This unique business model is why many of our employees come and stay!

Summary

Boulder Medical Center (BMC) is currently seeking Certified Coders to join our Quality team as a Risk Adjustment Coding Specialist! This position will work full-time 40 hours per week on Monday through Friday. This is benefit eligible and will enjoy evenings, weekends, and major holiday’s off. The Risk Adjustment Coding Specialist (RACS) is responsible for being resource and providing education and ongoing audits for providers on risk assessment (HCC) coding for all payers. The Risk Adjustment Coding Specialist confirms any risk adjustment errors and findings. Coders will need to understand the basis for medical record documentation, origination from the provider of service and in alignment with dates of service, service codes, and related HCC. Performs required and assigned chart audits, updates and provides feedback to Quality Program Supervisor for internal classes for correct coding, changes, and strategies. Remains current on HIPAA Compliance and maintains one or more coding certificates. Acts as in-house risk adjustment coding expert addressing and researching coding questions for BMC personnel. With direction from the Quality Program Supervisor, RACS can then communicate with physicians directly and work to promote positive coding guidelines

Job Duties

Educational and Auditing Support

  • Regulatory oversight and quality assurance
    • Support BMC’s quality programs that monitor, audit and improve the quality of provider medical record documentation, diagnosis coding, and the coding work of providers as it relates to risk adjustment.
    • Support strategies for effective and regular monitoring and auditing to identify risks, improve quality, and reduce risk stemming from potential CMS audits.
    • Provides regular, specialized coding classes for providers & medical staff to ensure correct and accurate risk adjustment coding.
    • Works and coordinates with outside coding consultants regarding risk assessment and HCC coding as needed and maximizes the impact to BMC of such consultations
    • Provider Engagement, training and support
      • Conduct ongoing training and education for new hire and current providers related to the HCC Risk Adjustment Process, proper medical record documentation, and diagnosis accuracy.
      • Collaborate with Quality Program Supervisor and payer partner representatives to understand quality initiatives and the relationship of risk adjustment to current metrics and incentive payments under these programs.
      • Support BMC in driving practice-wide risk adjustment initiatives.
      • Support the Quality Program Supervisor on the integration of prospective programs into the provider workflow and care management processes; promote the use of risk adjustment programs to help facilitate care management.
      • Collaborate with supervisor to project and monitor the impact of coding programs on revenue from CMS and other payers for budgets and plans. Performs all duties in accordance with business practices and approaches unique to BMC and their group practice status.
      • Understand and operates the Electronic Medical Records system.
      • Maintains a flexible, open attitude in regard to Electronic Medical Records. Attends mandatory Electronic Medical Records training, and participates in on-going Electronic Medical Records learning opportunities
      • Demonstrates a high level knowledge of HIPAA regulations and stay current with all updates

Coding

  • Confirm all risk adjustment diagnosis codes from acceptable provider documentation and in accordance with industry standards, CMS or HHS Risk Adjustment Guidelines
  • Adherence to current industry standard as defined in the ICD-10 guidelines for coding and correct reporting
  • Confirm accurate entry of risk adjusted codes into internal/external data bases as defined by State, Federal or other regulatory agencies.
  • Maintains current status, in good standing, with coding certificate(s). Seek & complete specialty coding classes & seminars to better assist BMC’s specialty offices.
  • Remains updated and fluent with AAPC and other coding bulletins, newsletters and guidelines pertaining to specialties particular to BMC in regards to risk adjustment coding.
  • Ability to support strategic direction for program operations, goals, metrics, tasks, timeframe, and appropriate reporting and timing related to all National HCC activities
  • Identify and apply best practices to ensure accuracy of risk adjustment coding is consistent across all payer partners
  • Reconcile data to outcomes and risk scores and trending patters to RAF scores
  • Monitor risk adjustment-related activities including but not limited to risk adjustment program payments, encounter data submission and return files to ensure all tasks are completed in a timely manner and achieve expected outcomes
  • Consistently exhibit behaviors and foster relationships with peers and internal stakeholders

Experience and Skills
Skills and Abilities:

  • Must be knowledgeable about Compliance/HIPAA rules and regulations.
  • Ability to coach, orient and mentor staff by demonstrating effective analytical and leadership skills;
  • Possess effective and collaborative interpersonal, communication and problem-solving skills and an ability to work within teams and within a dynamic work environment;
  • Uses good judgment to anticipate and assess training needs;
  • Must be able to set priorities and take initiative to effectively coordinate all coding activities associated with quality programs.
  • Must be able to multi-task, be flexible and detail-oriented with focus on strategy, analysis, planning and organizing to achieve quality improvement goals
  • Proficient computer application skills in Microsoft Office products to include Word, Excel and PowerPoint.
  • Familiarity with programs such as Electronic Health Records and vendor portals.
  • Extensive knowing in medical terminology and ability to research coding-related questions

Education:

  • High school diploma. Some college, preferred.
  • Certified Risk Coder with risk coding certification required; Certified Professional Coder (CPC) preferred.
  • 2 years minimum experience with chart audit and medical coding preferred.

Previous Experience:

  • Prefer 2-3 years of prior experience in healthcare practice or health plan operations.
  • Previous experience in risk adjustment coding activities in Medicare, ACA or provider organization with knowledge of CMS, State and other regulatory guidelines.

Salary Range:

  • $22.16 – $29.92 / per hour; depending on experience.

Location:

  • Boulder, CO

Job Benefits
BMC offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and STD as well as voluntary benefits, RTD EcoPass, 401(k), Paid Time Off and 6 holidays annually. Part-time employees are eligible for medical/dental/vision, company-paid life insurance, voluntary benefits, RTD EcoPass, and 401(k).