Title: Risk Adj Coding Specialist, Remote, Baptist Health Integrated Care, FT, 08:30A-5P -160371
Location: United States
Job Description:
Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in.
At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:
- Career growth and development opportunities, with clear pathways and ongoing support
- Comprehensive health and wellness resources that go beyond traditional benefits
- A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
- Tuition reimbursement to support continued learning and advancement
- And so much more
Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.
Description
Performs medical record reviews prior to and following annual wellness visits and other identified visits to determine appropriate ICD-10-CM coding and billing and compliance with Medicare Risk Adjustment metrics. Support continuum of patient care by identifying patients with gaps in care or in need of MRA metrics reporting prior to each qualified visit. Document detailed chart audit findings including documentation errors, diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis. Identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding. Identifies and documents coding observations or discrepancies and provides information to management team to further enhance quality and/or provider education. Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes. Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness diagnoses. Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices. Estimated pay range for this position is $23.21 - $29.48 / hour depending on experience.
Qualifications
Degrees:
- High School,Cert,GED,Trn,Exper.
Licenses & Certifications:
- AAPC Certified Professional Coder.
- AAPC Certified Risk Adjustment Coder.
Additional Qualifications:
- Certified Professional Coder and/or Certified Risk Adjustment Coder (CRC).
- CRC certification must be obtained within 1 year of hire.
- Required completion of an accredited certified coding specialist program.
- 2 + years of clinic or hospital experience and / or managed care experience.
- 1+ years of experience in Risk Adjustment and HEDIS/Stars.
- Ability to interpret, analyze and abstract data/documentation.
- Comprehensive knowledge of ICD-10-CM codes, Category II codes, COA measures, CMS documentation requirements, state and federal regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models.
- Ability to identify HCC improvement opportunities and educate clinical providers on proper clinical documentation, compliance, and coding guidelines.
- Intermediate level of proficiency in MS Office - Excel, PowerPoint, and Word.
- Ability to defend coding decisions to both internal and external audits.
- Strong organizational skills in multiple settings, as well as the ability to exercise judgment and initiative.
- Ability to work in a continuously changing environment.
Minimum Required Experience: 2 Years
Job: Corporate
Primary Location: Remote
Organization: Corporate
Schedule: Full-time
Unposting Date: Ongoing
EOE, including disability/vets
