Address
Form of workConduct medical records reviews with accurate diagnosis code abstraction in accordance with Official
Coding Guidelines and Conventions, *** IFP Coding Guidelines and Best Practices, HHS Protocols and any
additional applicable rule set.
Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data
capture, through the lens of HHS' Risk Adjustment.
Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk
adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs,
including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission
program. Inclusive of Quality Audits for vendor coding partners.
Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding
and Risk Adjustment education with internal and external partners.
Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks
or program gaps to management in a timely manner.
Communicate effectively across all audiences (verbal & written).
Top 3 Non-Negotiable Skills:
- AAPC and/or AHIMA Certification Needed
- Risk Adjustment Experience
- Able to work independently
.Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM
coding guidelines and conventions
Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and
coding compliance, with both Inpatient and Outpatient documentation
HCC coding experience preferred
Computer competency with excel, MS Word, Adobe Acrobat
Must be detail oriented, self-motivated, and have excellent organization skills
Understanding of medical claims submissions is preferred
Ability to meet timeline, productivity, and accuracy standards
