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Risk Adjustment Coding Specialist

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POST DATE 9/2/2016
END DATE 10/13/2016

Capital District Physicians' Health Plan, Inc Albany, NY

Albany, NY
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED


The Risk Adjustment Coding Specialist will be responsible for the chart review and ICD-9 / ICD-10 diagnosis coding of risk adjustment eligible members, including Medicare, Commercial Exchange, and Medicaid lines of business. This position will have responsibility to assist with audits (ex. RADV), chart retrieval coordination, tracking and trending of coding and documentation issues, and development of targeted provider education. This position will work closely with the Risk Coding and Education Specialist and the Risk Adjustment Audit Specialist to manage diagnosis code changes and processes related to risk adjustment, and develop best practices for medical record review and diagnosis code abstraction.



High school diploma or GED required. Associates degree preferred

CCS (Certified Coding Specialist) or CPC (Certified Coding Professional) credential required. If RN/LPN licensure, successful completion of AHIMA or AAPC certification within one year of employment is required. CRC (Certified Risk Adjustment Coder) credential preferred.

Strong knowledge of medical terminology, anatomy and physiology, and medical chart review required. Hierarchical Condition Category (HCC) and risk adjustment knowledge preferred.

Minimum of three (3) years in an HMO, Managed Care Organization or in a health care setting is required.

Demonstrated knowledge of medical record review and diagnosis coding within the health insurance industry is required. Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred.

Demonstrated ability to research, analyze and interpret CMS and State coding and documentation guidelines and apply to chart review, coding, and auditing.

Demonstrated ability to participate in project/initiatives that are code or code auditing related.

Strong verbal and written communication skills are required.

Excellent organizational and planning skills are required.

Knowledge of ICD-9 / ICD-10 diagnosis and procedure codes, CPT codes, Revenue codes, and HCPCS codes is required.

Achieve and maintain a coding accuracy rate of 95% or better.



As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices due to an applicant s race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law.