Supervisor Risk Adjustment Coding and Documentation     

Job Code: 29211    

 

Position Summary

This position serves as a subject matter expert (SME), leading and facilitating the improvement in the overall quality, completeness, and accuracy of practice-based clinical diagnosis coding and documentation for the Kootenai Care Network practice operations. Oversees the work of the coding and documentation team and is responsible for constructing audits and reviews to maintain alignment with network and compliance standards. 

 

Responsibilities

•    Serves as Risk Adjustment coding operational lead and coding subject matter expert for KCN practice operations

•    Reviews, directs, and guides the staff, assigning workloads and prioritizing task assignments to achieve maximum output

•    Provides support and oversight for network compliance activities related to federal and state requirements

•    Supports overread and validation of other coders' documentation review performance where appropriate; Develops program improvement plans and training materials

•    Leads the risk adjustment coding and documentation quality assurance process for the team, overseeing the workflow of the retrospective coding review

•    Identifies and implements practices and quality assurance process improvement opportunities, suggesting and educating appropriate solutions in accordance with nationally recognized coding guidelines

•    Verifies and ensures the accuracy, completeness, specificity, and appropriateness of risk adjustable diagnosis codes and clinical documentation based on services rendered

•    Performs root cause analysis to identify issues that may contribute to coding and documentation deficiencies

•    Engages KCN clinicians and their staff by supporting and educating on pre-visit planning to include identifying severity of patient illness

•    Improves the provider coding experience by ensuring KCN clinicians and their staff receive regular feedback regarding coded cases and opportunities for improved documentation

•    Supports KCN practices by analyzing chart documentation related to clinical status of patient, current treatment plan, past medical history and identifies potential gaps in provider documentation

•    Serves as a resource by educating KCN clinicians and their staff by identifying errors and issues related to diagnosis coding and documentation to bring about a positive network value program outcome

•    Actively engages and collaborates with payer partners on coding recapture and resolution of diagnosis

•    Utilizes software and population health application to collect, track, and communicate information related to diagnosis coding

•    Collaborates with KCN Contracting, Analytics and Information System teams to discern appropriate interventions for identified performance opportunities through enhancements or optimization to data, reports, and population health application

•    Evaluates staff performance, conducting quarterly and annual reviews

•    Familiar with standard concepts, practices, and procedures within the field 

•    Relies on experience and judgment to plan and accomplish goals

•    Regular and predictable attendance is an essential job function

•    Competent to meet age specific needs of the unit assigned

•    Performs other related duties as assigned

 

Requirements and Minimum Qualifications

•    Associate’s degree in related field or graduate of a formal coding program required; 3 years’ related experience may be accepted in lieu of degree

•    Minimum 3 years’ related experience required in addition to education requirement

•    Previous Risk Adjustment Methodology and diagnosis coding experience required

•    Coding certifications through AHIMA or AAPC; Outpatient Coding: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician, (CCS-P), or other related certification required

•    Certification as Risk Adjustment Coder preferred

•    Experience with Hierarchical Coding Category (HCC) Risk Adjustment Model preferred

•    HCC diagnosis coding and clinical record(s) review process preferred

•    Strong knowledge of CPT and ICD-10 coding and medical record documentation 

•    Proven history of project management and/or coordinating detailed projects or activities

•    Strong written and verbal communication skills, including ability to establish and build strong relationships

•    Ability to multi-task and deal with complex assignments on a frequent basis; strong organizational, time management, and project management skills

•    Strong analytical skills and the ability to interpret, evaluate, and formulate action plans based upon data

 

Working Conditions

•    Must be able to lift and move up to 10 lbs

•    Must be able to maintain a sitting position

•    Typical equipment used in an office job

•    Repetitive movements 

 

About Kootenai Health:  

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.  

As your next employer, we are excited to offer you:  

Kootenai Health offers comprehensive medical plan options, including options for fully paid employer premiums for our full-time employees. For part-time employees, we offer the same plan options with affordable part-time premiums. In addition to medical insurance, we offer many voluntary benefits ranging from dental and vision to life and pet insurance. Kootenai Health also offers well-being resources and telemedicine service options to all employees, regardless of benefit eligibility. Benefits begin on the 1st of the month following 30 days of employment.    Kootenai Health’s tuition assistance program is available after 90 days. If you want to further your education, we'll help you pay for it   Kootenai Health sponsors retirement plans for employees that enable you to save money on a pre-tax and Roth after tax basis for your retirement. Kootenai Health will match your contributions based on years of service ranging from 3-6 percent.    Competitive salaries with night, weekend, and PRN shift differentials   An award-winning and incentive-driven wellness program. Including a MyHealth corporate team, onsite financial seminars, and coaching    Employees receive discounts at The Wellness Bar, PEAK Fitness, and more   Robust and interactive employee referral program   And much more  

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!   

Apply today! Please contact the HR Front Desk at 208-625-4620 or email Lindsay Buchanan at lbuchanan@kh.org with any questions.   

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.