Coding Jobs in Birmingham, AL

Senior Risk Adjustment Specialist

The Senior Risk Adjustment Specialist reviews medical records to ensure all ICD-10-CM codes are accurate and compliant with supportive documentation for submission to the Centers for Medicare and Medicaid Services (CMS). This role is a resource for the Risk Adjustment Specialists and provides subject matter expertise.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

• Comprehensive Health, Vision, and Dental Coverage
• 401(k) Savings Plan with company match and immediate vesting
• Paid Time Off (PTO)
• 9 Paid Holidays annually plus a Floating Holiday to use as you choose
• Tuition Assistance
• Flexible Spending Accounts
• Healthcare Reimbursement Account
• Paid Parental Leave
• Community Service Time Off
• Life Insurance and Disability Coverage
• Employee Wellness Program
• Training and Development Programs to develop new skills and reach career goals
• Employee Assistance Program

Key Responsibilities

• Maintain thorough understanding of the risk-adjusted payment methodology; what can be submitted by the plan and how/when submission impacts CMS payments.
• Demonstrate knowledge of ICD10 coding guidelines, medical terminology, disease processes, and pharmacology.
• Interpret and demonstrate analytical and problem-solving ability to accurately assign ICD10 codes that are clinically identified and supported in the medical record.
• Work with department management to communicate provider coding accuracy concerns and challenges.
• Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
• Report findings of chart audits and Clinical Documentation Improvement (CDI) opportunities to providers to maximize the coding of ongoing risk adjusted conditions.
• Query providers when necessary to obtain clarification for unclear documentation.
• Collaborate with providers regarding coding changes, questions concerning documentation, diagnosis coding, and level of service.
• Conduct chart reviews to identify clinically supported diagnoses based on CMS-HCCs and specific HEDIS measures.
• Support any ongoing program that minimizes any organizational risk in the event of a Risk Adjustment Data Validation (RADV) audit.
• Communicate with Department Management to keep abreast of potential risk exposure related to coding and/or documentation practices by providers and/or coding personnel.
• Provide support and compliance through effective communication and training/education.
• Train and mentor new Risk Adjustment Specialists.
• Assist management with workflow improvements and process optimization.
• Serve as an escalation point for complex coding questions and issues.
• Monitor provider coding performance and trends.
• Evaluate coding practices for regulatory and compliance risk.
• Support RADV audits, validations, and related projects.

Required Qualifications:

• High School Diploma or GED
• At least 5-7 years' experience with coding
• Certified Coder (AHIMA or AAPC credentials)
• Read and interpret handwritten and typewritten medical documentation
• Ability to work under pressure to meet deadlines with minimal supervision
• Basic computer skills
• Ability to maintain flexible work schedule to meet department needs required
• Demonstrate excellent customer service skills through written and verbal communication
• Demonstrate leadership among coding team

Preferred Qualifications:

• 2 or more years of college
• Experience with hospital coding

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.