Healthcare - Risk Adjustment Outpatient Coder-Doc Specialist

• JOB SUMMARY/PURPOSE
• Develops, 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 CMS's 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 DESCRIPTION
• Health Plans 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; offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; also the third-party administrator for Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, is strategically and operationally aligned with Services’ mission of Building Healthier Communities Together.
• EXPERIENCE/EDUCATION/QUALIFICATIONS
• Bachelor’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 CMS-HCC (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.

Job Types: Full-time, Contract

Pay: $30.00 - $35.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Hybrid work

Education:

• Bachelor's (Required)

Experience:

• coding: 2 years (Required)
• CMS-HCC (Hierarchical Condition Category) model: 1 year (Required)
• MS Office (Excel, Word, PowerPoint): 1 year (Required)
• Epic Workflows: 1 year (Required)
• NLP coding platform: 1 year (Required)
• health plans: 1 year (Required)

License/Certification:

• RHIA, RHIT or CPC Certified Coder through AAPC and/or AHIMA (Required)
• Certified Risk Adjustment Coder (CRC) (Required)

Ability to Relocate:

• Corvallis, OR 97330: Relocate before starting work (Required)

Work Location: Hybrid remote in Corvallis, OR 97330