Risk Adjustment Coding Specialist (Remote in New York State)

Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.

The Risk Adjustment Coding Specialist will be responsible for the chart review and ICD-10 diagnosis coding of risk adjustment eligible members. This position will have responsibility for review of medical records to identify accurate ICD-10 diagnosis codes, chart retrieval activities, and occasional diagnosis code projects.

QUALIFICATIONS :

High school diploma or GED required. Associates degree preferred.

• CCS / CCS-P (Certified Coding Specialist) or CPC / CPC-A (Certified Coding Professional) required. If CCA or RN / LPN licensure, successful completion of AHIMA CCS / CCS-P or AAPC CPC certification within one year of employment is required.
• CRC (Certified Risk Adjustment Coder) credential preferred.
• Minimum one (1) year of experience in an HMO, Managed Care Organization or in a health care setting preferred.
• Strong knowledge of medical terminology, anatomy and physiology, and medical chart review required.
• Knowledge of ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codes required.
• Experience coding using an ICD-10-CM code book (without using encoder software) required.
• Working knowledge of HIPAA requirements, recognizing commitment to privacy, security, and the confidentiality of all medical chart and patient health information required.
• Chronic Conditions knowledge preferred.
• Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred.
• Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required.
• Experience with Clinical Documentation Improvement preferred.
• Demonstrated knowledge of medical record review and diagnosis coding within the health insurance industry.
• Demonstrated ability to research, analyze and interpret CMS and State coding and documentation guidelines and apply to chart review, coding, and auditing.
• Demonstrated ability to pro-actively identify problems, as well as recommend and / or implement effective solutions.
• Demonstrated ability to provide excellent customer service and develop relationships both internally and externally.
• Demonstrated ability to work with and maintain confidential information.
• Excellent verbal and written communication skills.
• Flexibility to adapt to a changing and fast-paced environment.
• Excellent organizational and planning skills.
• Exemplary attention to detail and completeness.
• Demonstrated success working remotely, without direct supervision.

CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https : / / www.cdphp.com / about-us / jobs / benefits .

As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.