Job Description
The Risk Adjustment Coder I reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Risk Adjustment Coder I is an HCC Coder and is responsible for ensuring proper risk adjustment coding of the Clinical Documentation Team, Physicians, Advanced Practice Providers (APPs), and other ambulatory team members across NM to improve the quality of documentation, ensure accurate representation of the care provided, and ensure accuracy in the HCC codes reported. The Risk Adjustment Coder I, CDI assists in improvement in the overall completeness and accuracy of quality data and outcomes through extensive interaction with physicians, nursing and administrative staff, interdisciplinary quality committees, and multidisciplinary teams. The Risk Adjustment Coder I, CDI is responsible for partnering with the Clinical Documentation team to properly code patient charts to ensure appropriate risk adjustment. The Risk Adjustment Coder I, CDI identifies issues, interprets internal/external issues, and helps lead problem resolution by communicating issues and frequencies to leadership. Functional areas of responsibility include clinical documentation at more than one business unit to assure effective workflow process design for ambulatory clinical documentation interventions that promote accurate and timely documentation and the coding of HCCs. As such, this does require regular travel to multiple NM Physician Practice sites within a geographical NM region. Clinical Documentation integrity efforts include accuracy of coding as related to HCC coding. Partners with key stakeholders to advance quality outcomes including, but not limited to, HCC Capture and Risk Adjustment Factor (RAF) Scores.
Responsibilities:
- Rounds and conducts in-person meetings, working with physicians, Advanced Practice Providers, and staff to ensure documentation is accurate.
- Utilizes technical coding expertise to assign appropriate ICD-10-CM diagnosis codes, as well as assist in appropriate assignment of risk adjustment.
- Assists with and completes special project work as assigned by Clinical Documentation Leadership.
- Conducts prospective and retrospective chart reviews for risk adjusting ICD10 codes/HCCs.
- Maintains advanced knowledge of coding all HCC diagnoses from the medical record in accordance with the ICD-10-CM coding guidelines.
- Maintains quality and productivity standards for coding review, code selection, and quantity of charts.
- Provides elbow-to-elbow support to physicians on best practice coding and documentation for Risk Adjustment.
- Maintains an understanding of disease process, anatomy and physiology, pharmacology, and medical terminology.
Additional Functions
- Participates in a minimum of one NM Clinical Documentation committee as approved by Manager, Clinical Documentation – Ambulatory.
- Participates in hospital committees/task forces as approved by manager/director.
Qualifications
Required:
- 2 years of experience working in healthcare or in a professional business environment.
- Associate’s Degree in a related field such as business or healthcare. In lieu of an Associate’s Degree, must have an additional 2 years of relevant professional business or healthcare experience.
- Must possess and consistently demonstrate:
- Strong interpersonal, communication, conflict management, diplomacy and negotiation skills.
- Analytical skills necessary to independently collect analyze and interpret clinical data.
- Basic computer skills and willingness to learn computer applications relative to this position.
- A continuous interest in learning new material.
Preferred:
- Bachelor’s Degree in a related field.
- Experience working within Ambulatory Care.
Additional Information
Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.
If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.
