[Hiring] Risk Adjustment Coding and Documentation Specialist @Kootenai Health

Role Description

This position is responsible for facilitating the improvement in the overall quality, completeness, and accuracy of practice-based clinical diagnosis coding and documentation.

Responsibilities

• Verifies and ensures the accuracy, completeness, specificity, and appropriateness of risk adjustable diagnosis codes and clinical documentation based on services rendered.
• Engages KCN clinicians and their staff by supporting and educating on pre-visit planning to include identifying severity of patient illness.
• Improves the provider coding experience by ensuring KCN clinicians and their staff receive regular feedback regarding coded cases and opportunities for improved documentation.
• Supports KCN practices by analyzing chart documentation related to clinical status of patient, current treatment plan, past medical history and identifies potential gaps in provider documentation.
• Serves as a resource by independently educating KCN clinicians and their staff by identifying errors and issues related to diagnosis coding and documentation to bring about a positive network value program outcome.
• Develops program improvement plans and training materials.
• Suggests and educates appropriate solutions in accordance with nationally recognized coding guidelines.
• Actively engages and collaborates with payer partners on coding recapture and resolution of diagnosis.
• Utilizes software and population health application to collect, track, and communicate information related to diagnosis coding.
• Collaborates with KCN Contracting, Analytics and Information System teams to discern appropriate interventions for identified performance opportunities through enhancements or optimization to data, reports and population health application.
• Performs other related duties as assigned.
• Familiar with standard concepts, practices, and procedures within the field.
• Relies on experience and judgment to plan and accomplish goals.
• Regular and predictable attendance is an essential job function.
• Competent to meet age specific needs of the unit assigned.

Qualifications

• Graduate of a formal coding program or completion of a coding training course preferred.
• Associate degree preferred.
• Minimum 3 years' coding/medical record chart review experience in a healthcare setting required.
• Previous Risk Adjustment Methodology and diagnosis coding experience required.
• Coding certifications through AHIMA or AAPC; Outpatient Coding: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCS-P), or other related certification required.
• Clinical Documentations Expert Outpatient (CDEO) certification required within 12 months of hire.
• Certification as Risk Adjustment Coder preferred.
• Experience with Hierarchical Coding Category (HCC) Risk Adjustment Model preferred.
• HCC diagnosis coding and clinical record(s) review process preferred.
• Strong knowledge of CPT and ICD-10 coding and medical record documentation.
• Proven history of project management and/or coordinating detailed projects or activities.
• Strong written and verbal communication skills, including ability to establish and build strong relationships.

Requirements

• Must be able to lift and move up to 10lbs.
• Must be able to maintain a sitting position.
• Typical equipment used in an office job.
• Repetitive movements.

Benefits

• Comprehensive medical coverage, including fully employer‑paid options for eligible full‑time employees, plus affordable plans for part‑time staff. Benefits begin on the 1st of the month following 30 days of employment.
• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees.
• Tuition assistance after 90 days to support your professional growth.
• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%.
• Competitive pay, plus night, weekend, and PRN shift differentials.
• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps.
• PerkSpot discounts providing access to thousands of exclusive deals in over 25 categories.
• An employee referral bonus program.