Certified Risk Adjustment Coding Specialist
Trinity Health PACE

Livonia, Michigan

Posted in Medical and Nursing

Job Info

Employment Type:
Full time


Trinity Health PACE is seeking an experienced Certified Risk Adjustment Coding Specialist to join our team. This is a REMOTE position with flexible start time working Monday through Friday.

The primary purpose of this position is to assign the appropriate diagnostic and procedural (if applicable) ICD/CPT codes to individual participant health information for data retrieval, analysis and claims processing. The certified risk adjustment coding specialist will abstract data from medical record within specified time frames and retain, validate and provide specialized education regarding documentation to support HCC's.

Corporate offices for Trinity Health PACE are in Livonia, Michigan. All equipment and comprehensive training will be provided. Training will take place in person in Livonia, Michigan for two weeks (expenses paid).

The Program of All-Inclusive Care for the Elderly (PACE) model is centered on the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible. We encourage fellowship and independence while serving seniors and their families with dignity and respect.

Trinity Health PACE provides a competitive compensation and benefit package that complements this opportunity for personal growth and professional advancement. This position reports to the Certified Medical Coding Manager.

General responsibilities will include:
• Per standard process reviews and evaluates participant medical records to identify diagnoses and procedures and accurately assigns and sequences ICD and CPT codes. Abstracts and validates information. Seeks out validating i formation (queries physicians, clinicians) when provided information is inadequate, ambiguous or unclear for coding purposes
• Responsible for documentation spot checks and audit responses. Responds/corrects audit feedback.
• Assures that accurate, complete client care documentation is completed timely, in preparation for billing (RAPS, charge tickets, etc). Validates RAPS submission files.
• Ensures staff are aware of and respond to alerts/queries/questions by computer, voice mail and other means. Provides feedback to clinicians and others that support completion of plans within site timelines.
• Monitors and informs manager of records that are not completed timely. Monitors, investigates and takes appropriate action for records that are not coded, billed, or rejected.
• Keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to manager.
• Works with manager to identify, develop and implement strategies for quality improvement.
• Maintains participant confidentiality and abides by HIPAA guidelines. Assures site staff compliance with federal/state and accreditation regulations through record review, case conferencing and communication.

• High school diploma or equivalent required. 2 years of completed college coursework preferred.
• Must have one of the following certifications: Certified Outpatient Coder, Certified Coding Specialist, Certified Professional Coder thru AAPC or Registered Health Information Technologist or Registered Health Information Administrator thru AHIMA
• Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC.
• Two-years of experience in a risk adjustment coding environment required
• Demonstrates the ability to verify and validate HCCs.
• Demonstrates the knowledge and ability to work with providers on education and guidance.
• Demonstrates knowledge of medical terminology, human anatomy and physiology, and diseases processes.
• Must be action-oriented, have business acumen, manage conflict well, be customer focused, have high decision quality, flexibility to adapt to ongoing change and have organizational agility.
• Demonstrates superior written and verbal communication and presentation skills appropriate for audience comprehension. Able to communicate effectively with individuals and groups representing diverse perspectives.
• Comprehensive to expert proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.); basic knowledge and experience with electronic mail and calendaring system. Ability to use other software as required to perform the essential functions of the job.
• Possesses a high degree of personal accountability, responsibility and independent decision-making
• Excellent organizational skills. Ability to change and be flexible with work priorities. Strong problem-solving skills.
• Must exhibit critical thinking skills and possess the ability to prioritize workload.
• Position may require occasional travel to home office in Livonia, MI.

Apply today!

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

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