Join our team as a Risk Adjusted Coder at our Toppenish Central Administration in Toppenish, WA!
Be part of a healthcare organization that believes in making a difference beyond medical care! We've transformed into a leading community health center in the Pacific Northwest with 40+ clinics across Washington and Oregon. We offer a wide range of services such as medical, dental, pharmacy, orthodontia, nutritional counseling, autism screening, and behavioral health. Our holistic model also extends assistance to shelter, energy, weatherization, HIV and AIDS counseling, home visits, and mobile medical/dental clinics.
Explore our short clips, "WE are Yakima - WE are Family" and "YVFWC - And then we grew," for a glimpse into our dedication to our communities, health, and families.
Visit our website at www.yvfwc.com to learn more about our organization.
Position Highlights:
$26.22-$32.12 DOE with the ability to go higher for highly experienced candidates
100% employer-paid health insurance including medical, dental, vision, Rx, and 24/7 telemedicine
Profit sharing & 403(b) retirement plan available
Generous PTO, 8 paid holidays, and much more!
What You’ll Do:
- Support updating YVFWC coding policies & procedures to reflect changes of the ICD-10 CM Official Guidelines for Coding and Reporting, new AHA Coding Clinic Advice and new guidance from Center for Medicare & Medicaid Services (CMS). Interpret changes in the external regulatory environment and support modifying YVFWC policies accordingly in coordination with the Population Health & Revenue Cycle departments. Keep current on regulatory and coding issues/best practices, including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.
- Present findings via verbal and written updates to internal and external audiences, including peer-to-peer, department leadership (Manager, Director, Sr. Director, VPs) reporting, provider and clinical teams, and vendor support teams.
- Serve as Risk Adjustment coding operational SME.
- Implement post-visit review covering both diagnoses and encounter queries to providers prior to submitting claims for CHPW members. Ensure that all reported ICD-10-CM and CPT codes are supported by encounter documentation. Initiate query to provider when the most specific, accurate code assignment cannot be achieved without clinical clarification.
- Identify and advocate for practices and process improvement opportunities.
- Monitor charges within assigned charge-review work queues to ensure applicable internal coding guidelines, applicable YVFWC policies, and CMS risk adjustment guidelines, rules, and regulations are adhered to.
- Perform root cause analysis to identify issues that may contribute to coding and documentation deficiencies.
- Employees are expected to report to work as scheduled, participate in all assigned meetings, and meet established performance and accountability standards.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer at its sole discretion.
Qualifications:
- High School Diploma.
- Minimum two (2) years medical professional coding experience.
- Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs) and HHS-HCC.
- FQHC Billing Experience Preferred. One year experience working in a healthcare setting with Epic software preferred.
- Successful completion of one of the certificates listed below is required at time of hire:
- American Health Information Management (AHIMA), or
- Certified Coding Specialist (CCS), or
- Registered Health Information Technician (RHIT), or
- American Academy of Professional Coder (AAPC), or
- Certified Professional Coder (CPC), or
- Certified Professional Coder – Hospital (CPC-H) Coding, or
- Certified Risk Adjusted Coder (CRC) OR Risk Adjustment Coding (RAC) if AHIMA-certified. or
- Certified Professional Medical Auditor (CPMA)
- Proficiency and experience with a variety of computer programs, including EpiCare, Prelude, Resolute PB, Word, and Excel. Basic understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs). Knowledge of acceptable medical record standards and criteria in the context of risk adjustment data validation (RADV) audit. Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers. Ability to multi-task and deal with complex assignments on a frequent basis; strong organizational, time management, and project management skills. Ability to design and update provider feedback report templates. Strong analytical skills and the ability to interpret, evaluate, and formulate action plans based upon data. Proficiency and experience with Microsoft Office products. Maintain consistent performance and attendance standards. Positive and constructive attitude with a team approach. Effective verbal, written and listening communication skills are essential.
Our Mission Statement
“Together we transform our communities through compassionate, individualized care, eliminating barriers to health and well-being.”
Our mission celebrates inclusivity. We are committed to equal-opportunity employment.
Contact us at jobs@yvfwc.org to learn more about this opportunity!
Equal employment opportunity, including veterans and individuals with disabilities.
