Job Description:

Edifecs

Risk Adjustment Coding Advisor Temp Position

Overview

Edifecs is seeking a Risk Adjustment Coding Advisor to join our Risk Adjustment team. This role involves leveraging clinical, coding, documentation, and analytical skills to develop technology solutions for Health Plans and Providers. The ideal candidate will possess a unique combination of technical ability, clinical experience (including ICD-10 coding and clinical documentation), and problem-solving skills. This is temporary 2 month position.

What you will do:

• Recommend process improvements to enhance coding quality goals and outcomes.
• Validate and troubleshoot Natural Language Processing (NLP) outputs from clinical documentation.
• Oversee coding projects, including training third-party coding vendors and reviewing coding guidelines.
• Develop content for training guides and webinars.
• Conduct training and education related to audit outcomes.
• Perform quality assurance tasks for Informatics releases.
• Collaborate with Informatics Engineers to analyze client data.
• Work with the Product Management team to integrate Informatics deliverables into existing products.
• Develop business requirements and create user workflows.
• Articulate the customer value derived from products.
• Prepare educational videos and content as needed.
• Review and understand customer coding guidelines.
• Perform user acceptance testing for products.
• Provide timely product support in collaboration with the Customer Success team.
• Integrate technology solutions with third-party vendors for customers.
• Support subject matter expert conversations with existing and new customers.
• Perform and validate code abstraction and conduct coding quality audits of medical records to ensure accurate ICD-10-CM code assignment.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations

What you will bring:

• Bachelors degree or equivalent experience.
• Medical coding certification (RHIA, RHIT, CCS, CPC, or CRC) with 3-5 years of coding and auditing experience.
• LPN or RN with coding/documentation skills/certification is a plus.
• Working knowledge of risk adjustment models including CMS-HCC, HHS-HCC, and CDPS.
• Experience with standardized clinical terminologies such as ICD-10 and CPT-4.
• Excellent knowledge of coding guidelines and updates; knowledge of risk adjustment and HCC coding.
• Strong understanding of anatomy, physiology, disease processes, and medical terminology.
• Familiarity with standard clinical terminologies like SNOMED and RxNORM (preferred).
• Experience with RADV or RAC audit processes (preferred).
• Experience with at least one Electronic Health Record (EHR) system (e.g., Epic, Athena, Centricity, Cerner).
• Experience in a healthcare IT environment.
• Strong analytical, troubleshooting, and problem-solving skills.
• Willingness to learn new technical skills such as database querying.

Note:Theexpectedhourly pay range for this position is $40-$45/hour.Hourlypay offered may vary depending on location, job-related knowledge, education, and experience.

About Edifecs

Edifecsis a premier technology company in the U.S. Healthcare market with solutions focused on interoperability, workflows, risk adjustment, value-based care payments, and analytics.Edifecssolutions are used by leading healthcare entities including, payers, providers, employers,third-partyadministrators, and government agencies. With innovative technology and solutions,Edifecshelps its customers by optimizing the secure exchange and processing of administrative and clinical data, reducing the cost of complying with regulations, and automating workflows involved in multiple core processes within the healthcare ecosystem.Edifecsis a frontrunner in providing solutions for B2B data exchange, streamlining key workflows in areas such as enrollment, risk adjustment, and alternative payment models. With the advent of FHIR and new regulatory guidance from HHS,Edifecshas emerged as a leader in easing the effort associated withachieving compliance with new federal rules and in making the healthcare consumer the primary stakeholder.Edifecssolutions are offered in bothOn-Premiseand SaaS models. The company is headquartered in Bellevue, Washington, with additional offices in Atlanta, Georgia,and Mohali, India, an engineering center in Moldova, and has more than 700 employees.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or another legally protected status.

Edifecs will provide reasonable accommodation to individuals with disabilities who need assistance applying for a job. Please contact careers@edifecs.com for more information.

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