OR - Risk Adjustment Outpatient Coder-Doc Spec

JOB SUMMARY/PURPOSEDevelops implements and maintains auditing practices related to medical record coding and documentation to enhance risk adjustment outcomes for Medicare members. Ensures member medical records comply with CMSs Risk Adjustment Data Validation procedures. Responsible for ensuring risk score accuracy identifying and communicating coding and documentation quality trends and developing provider intervention strategies.DEPARTMENT DESCRIPTIONSamaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans Inc. offers Medicare Advantage Commercial Large Group and Commercial Large Group PPO and EPO plans; SHP is also the thirdparty administrator for Samaritan Health Services selffunded employee health benefit plan. As part of an Integrated Delivery System Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.EXPERIENCE/EDUCATION/QUALIFICATIONSBachelor s Degree or equivalent experience required.Current RHIA RHIT or CPC Certified Coder through AAPC and/or AHIMA required.Certified Risk Adjustment Coder (CRC) preferred.Two (2) years coding experience with at least one (1) year of specialized experience with the CMSHCC (Hierarchical Condition Category) model required.Experience with computer applications including MS Office (Excel Word PowerPoint) required.Experience with Epic workflows preferred.Experience working in NLP coding platform preferred.Must have experience with health plans.

Shift: Days no weekends

Specialty Type: Medical Coding

Sub Specialties: Outpatient Coder

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