Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
The Bright Health Risk Adjustment and Coding Team is an integral component of Bright’s success as it defines and ensures outstanding clinical care for our members. As a Coding Coordinator you will act as a primary coding contact for compliance oversight with a focus on accuracy and potential coding opportunities. The Coding Coordinator will also be responsible for secondary level quality reviews.
ROLE RESPONSIBILITIES
1. Participate in risk adjustment coding reviews including but not limited to vendor bi-directional chart chases, gap closure, and coding completeness
2. Responsible for performing code abstraction and/or coding quality audits of medical records to ensure that the ICD-10-CM codes are appropriately assigned and supported by clinical documentation
3. Identifies and tracks areas for documentation improvements and participates in documentation improvement initiatives
4. Participate in quality reviews of vendor’s work for RADV audits and other risk adjustment projects
5. Play a role in medical records retrieval; including but not limited to calling provider offices, obtaining medical records from EMR systems, and partnering with market nurses for retrieval
6. Maintain all coding certifications and requirements and keep up to date on knowledge of ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines
7. Meet and maintain coding quality and productivity standards
8. Ensure compliance with all federal rules and regulations
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Associate degree or Bachelor’s degree required
- Three (3) or more years’ experience in Medicare Advantage and Commercial coding and risk adjustment
- Current coding certification through AAPC or AHIMA
- Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines
- Extensive knowledge of Medicare Advantage and Commercial HCC models
- Proficient in Microsoft Office Products; Word, Excel, Powerpoint
Preferred
- Certified Risk Adjustment Coder (CRC)
- Medical record retrieval experience
PROFESSIONAL COMPETENCIES
- Strong written and verbal communication skills
- Strong attention to detail
- Vast knowledge of EMR systems, medical record review and abstraction
- Ability to quickly learn and adapt to meet business needs
- Experience working with Risk Adjustment vendors
- Ability to work independently
- Ability to build relationships with office staff, physicians, and market team
LICENSURES AND CERTIFICATIONS
- Current coding certification through AAPC or AHIMA
- Certified Risk Adjustment Coder (CRC) preferred
WORK ENVIRONMENT
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.
We’re Making Healthcare Right. Together.
We are realizing a completely different healthcare experience where payors, providers, doctors, and patients can all feel connected, aligned and unified on the same team. By eradicating the frictions of competing needs, we are making it possible to give everyone more of what they want and deserve. We do this by:
Focusing on Consumers
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
Building on Alignment
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.
Powered by Technology
We employ our purpose built, integrated data platform to connect clinical, financial, and social data, to deliver exceptional outcomes.
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. 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.
Bright Health
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