Coding Specialist - Risk Adjustment Office Based- Irvine, CA - Full-time / Part-time

We’re Monarch HealthCare, Orange County’s largest association of independent physicians, and a part of Optum and the growing family of UnitedHealth Group companies. We are changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. With the talent, resources and can - do culture of a Fortune 6 company behind us, there’s no telling how far we can go. Join us in creating a better future and you’ll soon find you’re doing your life’s best work.(sm)
 
Risk Adjustment Coding Education Specialist:
 
Summary: Responsible for risk adjustment coding team operations including physician coding and documentation education, diagnostic attestation processing, chart reviews, and development of tools to assist in PCP and / or Specialist coding success.  Review patient records for accurate and compliant coding and documentation to support appropriate reimbursement based on the HCC model. The Coding Educator Specialist is expected to work directly with Physicians and Midlevel Providers to proactively review medical records for compliant documentation and other clinical documentation to identify possible risk adjusted codes.
 
Primary Responsibilities:

Reviews and analyzes patient medical records in providers’ offices or remotely.   Ensures the records have been appropriately ICD - 10 coded to the highest level of specificity
Assists in the processing of attestations from providers to review for compliant and accurate documentation of current HCC conditions
Educates physicians, office staff, billers on CMS - HCC risk adjustment model, CDPS risk adjustment model, ACO risk adjustment model and how to utilize available reports and tools, and other related projects and initiatives
Responsible for administrative duties related to planning, scheduling, and conducting coding audits with physicians
Assists internal and external departments with billing and coding questions as well as risk adjustment related questions

Required Qualifications:

High school education or GED
Coding certification (CCS or CPC through AHIMA / AAPC
4 or more years ICD - 9 / 10 hands on coding experience - preferably in a managed care setting
MS office - Word / Excel
Ability to travel  20% to local physician offices for education / training
Preferred Requirements:

CPT and HCPCS coding experience
Experience with risk adjustment
Managed care experience
Experience presenting complex information and or training materials
What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: Coding Certification, CCS, AHIMMA, AAPC, Risk Adjustment, Managed Care, CP, HCPCS, Senior, Medical Coder, Irvine, CA