Job Description Summary
LEVEL II – RISK ADJUSTMENT CODING SPECIALIST (Intermediate)
(Includes all Level I responsibilities + the following)
Responsibilities
- Abstract and assign ICD 10 CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher level coders.
- Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.[HO1.1]
- Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
- Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
- Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
- Consistently meet or exceed accuracy and productivity benchmarks.
- May be assigned additional projects or a higher workload volume than a Level I specialist.
How will you make an impact & Requirements
LEVEL II – RISK ADJUSTMENT CODING SPECIALIST (Intermediate)
(Includes all Level I responsibilities + the following)
Responsibilities
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Abstract and assign ICD‑10‑CM diagnosis codes supported in encounter documentation and work independently with minimal oversight from leadership or higher‑level coders.
-
Conduct retrospective audits of medical records to validate diagnosis coding accuracy, completeness, and claim submission quality.
-
Perform comprehensive reviews of provider actions within the Value‑Based Alert Tool (VBAT) to identify outliers and improvement opportunities.
-
Analyze Medicare Risk Adjustment (MRA) data to identify coding or documentation patterns and assist in developing interventions at the provider or regional level.
-
Keep leadership aware of project activities through written and oral updates; proactively identify project risks.
-
Consistently meet or exceed accuracy and productivity benchmarks.
-
May be assigned additional projects or a higher workload volume than a Level I specialist.
Qualifications
(In addition to Level I minimum qualifications)
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Minimum 2 years of coding or related medical experience, including 1 year of HCC coding.
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Advanced knowledge of medical terminology, anatomy, physiology, and disease processes.
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Extensive understanding of ICD‑10‑CM conventions, documentation standards, and reimbursement systems.
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Strong technical skills, including proficiency with MS Office (Excel, Word, Access, PowerPoint).
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Demonstrated ability to use a variety of electronic medical record systems.
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Ability to manage a significant workload and meet deadlines with minimal supervision.
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Strong organizational, analytical, mathematical, and problem‑solving skills.
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Effective written and verbal communication abilities.
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Experience contributing to project work, educational development, or group presentations.
