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Risk Adjustment Coding and Chart Coord

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POST DATE 9/15/2016
END DATE 11/3/2016

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 and Chart Coordinator will be responsible for a number of key elements that drive success in the CDPHP Risk Adjustment programs. This includes, but is not limited to, medical record retrieval, record review for ICD-9 / ICD-10 risk adjusted diagnosis codes, transmission of medical records to vendors, Provider follow up on record requests, and internal and external audit support (Risk Adjustment Data Validation (RADV)). This position will also provide project coordination and administrative support for multiple initiatives relating to Medicare, Medicaid, and Commercial Health Exchange.


* High school diploma or GED required. Associates degree preferred.

* CCS (Certified Coding Specialist) or CPC (Certified Coding Professional) credential required. Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Professional Coder Payer (CPC-P), or RN/LPN will be considered with successful completion of CPC or CCS certification within one year of employment. Additional CRC (Certified Risk Adjustment Coder) credential preferred.

* Minimum of two (2) years in an HMO, Managed Care Organization or in a health care setting is required. Medical record review preferred.

* Demonstrated knowledge of medical record review and diagnosis coding within the health insurance industry is preferred.

* Experience in claims adjudication, billing and enrollment systems, product or pricing is preferred.

* Demonstrated ability to coordinate and organize projects involving medical record retrieval across a large number of locations.

* 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.

* Strong knowledge of medical terminology, anatomy and physiology, and medical chart review required. Provider office relations and communication experience strongly preferred. Hierarchical Condition Category (HCC) knowledge preferred.

Salary Grade: 13

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.