Adjustment Clerk jobs in Washington

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About the Role

As a Risk Adjustment Coder for Community Health Plan of Washington, you will be responsible for ensuring accurate and timely coding of medical records to support risk adjustment activities.  Work scope includes coding medical charts, supporting chart audits, and reviewing output from coding vendors.

To be successful in this role, you:

• Have a minimum of 2-3 years of experience in risk adjustment coding, preferably in a health plan setting.
• Have a minimum of 2-3 years of experience with Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Categories (HCCs) and/or HHS-HCC models.
• Are an American Health Information Management (AHIMA) Certified Coding Specialist (CCS) or American Academy of Professional Coder (AAPC), Certified Professional Coder (CPC) or Certified Professional Coder – Hospital (CPC-H) Coding Certification.
• Are a certified Risk Adjusted Coder (CRC).
• Proficiency in Microsoft Office applications such as Outlook, Excel, Word, and Power Point.
• Have experience with experience with Medicaid Chronic Illness and Disability Payment System (CDPS) model preferred.
• Have experience with Natural Language Processing (NLP), computer assisted coding applications preferred.

Essential functions and Roles and Responsibilities:

• Review, analyze, and audit medical records, encounter forms, and other documentation to accurately validate and assign ICD-10-CM, and other relevant codes for risk adjustment coding & audit purposes.
• Ensure all claims are coded accurately, completely, and in compliance with all regulatory requirements and health plan policies.
• Provide verbal and written reporting on weekly coding audit results and trends to risk adjustment team coding leadership using defined templates, emails, and meetings.
• Collaborate with health plan staff, risk adjustment team members, and other stakeholders to resolve coding-related issues and concerns.
• Support coding processes and procedures to ensure compliance with coding guidelines and regulations.
• Participate in cross-functional teams to support health plan initiatives related to coding and risk adjustment submissions.
• Maintain 95% coding accuracy rate, and minimum charts per hour performance (as defined with manager).
• Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.

Knowledge, Skills, and Abilities:

• Knowledge of ICD-10-CM and other relevant code sets required. CPT and HCPCS preferred.
• Knowledge of risk adjustment coding guidelines, regulations, and industry trends and best practices.
• Communication and interpersonal skills, with the ability to collaborate with a variety of stakeholders.
• Skilled at completing assignments with attention to detail and accuracy.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check.

Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant’s criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:

The position is FLSA Non-Exempt and is not eligible for overtime. Based on market data, this position grade is 41 and has a 5% annual incentive target based on company, department, and individual performance goals.

CHPW offers the following benefits for Full and Part-time employees and their dependents:

•  Medical, Prescription, Dental, and Vision
•  Telehealth app
•  Flexible Spending Accounts, Health Savings Accounts
•  Basic Life AD&D, Short and Long-Term Disability
•  Voluntary Life, Critical Care, and Long-Term Care Insurance
•  401(k) Retirement and generous employer match
•  Employee Assistance Program and Mental Fitness app
•  Financial Coaching, Identity Theft Protection
•  Time off including PTO accrual starting at 17 days per year
•  40 hours Community Service volunteer time
•  10 standard holidays, 2 floating holidays
•  Compassion time off, jury duty

Sensory/Physical/Mental Requirements:

Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.

Mental:

• Must be able to manage conflict, communicate effectively and meet time-sensitive deadlines.

Work Environment:

Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.