Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Risk Adjustment Coder

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Manager & Professional
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EmblemHealth
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Review supplied medical records to determine if diagnosis codes are properly mapping to HCCs Government (CMS, HHS, State) documentation guidelines.  Assist with chart retrieval and coding vendors to execute the HCC Data Confirmation Program.Support the HCC Coding manager on Vendor coding validations with SLAAssist in other initiatives and projects as needed. Maintain a 95% or better coding accuracy through routine performance reviews.


Responsibilities:

  • Comply with all legal requirements regarding coding procedures and practices
  • Evaluate each medical record to ensure that M.E.A.T. criteria support the existence of all submitted diagnosis codes
  • Identify, assess and delete submitted diagnosis codes for CMS submission requirements.
  • Working with HCC Coding Manager and with external vendors to ensure complete and accurate analysis of system codes.    
  • Work with HCC Coding manager to drive external vendors to an in-house function.
  • Work with HCC Coding Manager to address any coding adds/edits/deletes
  • Work with HCC Director and Coding manager to support the Enterprise Risk Adjustment HCC Data Confirmation Program.    
  • Identify diagnosis conditions that will support coding education sessions for the provider community to improve risk adjustment coding. 
  • Monitor, analyze and assist HCC Coding Manager to prepare reporting of coding results overall and by provider.
  • Regularly meet with HCC Director and Coding Manager to share results of specific coding activities. 
  • Maintain industry coding knowledge, certifications and enterprise wide CMS coding compliance SME.    
  • Assist in other initiatives and projects as needed.     
     

Qualifications:

  • Bachelor’s Degree
  • Required certifications: Risk Adjustment Coder (CRC); Professional Coder (CPC)
  • 2-3 years of related work experience (R)
  • Additional experience/specialized training may be considered in lieu of educational requirements (R)
  • Experience with working in a compliance related function across a large division, department, or company (R)
  • Self-starter with ability to work with multiple levels of management and handle multiple tasks successfully  (R) 
  • Prior experience working with external vendors (R)
  • Proven track record of collaboration and coordination across all levels and areas/divisions of provider organizations (R) 
  • Effective communications skills (verbal and written) with all types and levels of audiences (R) 
  • Proficiency with MS Office applications (word processing, spreadsheet/database, presentation) (R)
  • Energetic and enthusiastic with a positive attitude (R) 
  • Knowledge of healthcare operational processes and products (P)
  • Excellent analytical skills (R)
  • Proficiency with computer and data entry retrieval skills (R) 
  • Experience with HCC Model, ACA model and Medicaid model  (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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