Health Risk Coding & Education Specialist II (Hybrid - Troy, MI) - Health Alliance Plan

Henry Ford Health - Troy, MI

Full-time - Mid Level

Hybrid - Troy, MI

Ambulatory Health Care Services

About the position

The Health Risk Coding & Education Specialist II will be responsible for conducting comprehensive chart reviews and audits to ensure compliance with coding and documentation standards, particularly focusing on diagnosis codes related to Hierarchical Condition Categories (HCC). This role involves engaging with in-network providers to identify trends, provide education, and support the Risk Adjustment Coding and Clinical Education team in various auditing processes.

Responsibilities

• Conduct retrospective, concurrent, and prospective chart reviews and audits to ensure compliance with coding standards.
• Assist with CMS and HHS mandatory audits, including documentation and coding for Medicare Advantage Risk Adjustment Data Validation.
• Complete necessary paperwork and documentation for provider medical records and audits.
• Conduct HCC-focused reviews on providers, tracking results and identifying trends for follow-up training.
• Generate reports to identify low risk score providers and those with low HCC reporting.
• Communicate audit processes and results to relevant departments and provider groups.
• Develop educational materials and outreach strategies for providers.
• Provide health risk clinical documentation and coding education to providers and internal teams.
• Collaborate with vendors and provider offices to secure medical records.
• Participate in quality improvement initiatives and continuing education activities.

Requirements

• Associate's degree in Health Information Management, Health Information Technology, or related field required.
• Bachelor's degree or equivalent work experience preferred.
• Two years of coding experience in diagnostic and procedural coding required.
• Proficiency in ICD-9-CM and ICD-10-CM coding required.
• Knowledge of medical billing and third-party payer regulations preferred.
• Excellent communication skills and ability to work with multiple departments.
• Strong knowledge of anatomy, physiology, and medical terminology.
• Registered Health Information Administrator (RHIA) or Registered Health Information Technician (RHIT) or Certified Professional Coder (CPC) required.

Nice-to-haves

• Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P) preferred.
• Knowledge of Medicare Advantage risk adjustment payment methodology preferred.
• Knowledge of CMS programs and payment principles preferred.
• Familiarity with Adobe Pro preferred.

Benefits

• Health insurance
• Dental insurance
• Tuition reimbursement