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At Hill Physicians Medical Group, we’re shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

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Hill Physicians has much to offer prospective employees. We’re regularly recognized as one of the “Best Places to Work in the Bay Area” and have been recognized as one of the “Healthiest Places to Work in the Bay Area.” When you join our team, you’re making a great choice for your professional career and your personal satisfaction.

The Risk Adjustment Coder I provides support and coding expertise to all programs that support risk adjustment and data validation efforts for our Medicare and Commercial lines of business, along with other ad hoc and long-term projects assigned by the Manager, Government Programs. These projects impact revenue and prepare us for health plan, CMS, and HHS audits. In addition, the Risk Adjustment Coder will provide analytics, education, in-person trainings in provider offices, and serve as the subject matter expert for all HCC coding initiatives, policies, and procedures that adhere to our organization's coding guidelines and compliance standards. The position will interact with physician leadership, the provider network, and internal departments within the organization (e.g., Regional Services, Clinical Services, and Case Management). The ability to develop and maintain key relationships across the company will be critical.

Essential Responsibilities

• Risk adjustment data validation to ensure accurate code submission.
• Develop HCC education materials for practices, panel meetings, new physician orientation, provider SMT and internal departments.
• Provide train the trainer sessions to internal departments on risk adjustment and coding interventions – to educate the provider network.
• Coordinates AWV/Quality resources and monitors performance of interventions
• Responsible for presenting Government Programs updates (Practice Manager Meetings, SMT, HillMetrics Support Forums, etc.)
• Identify opportunities to improve documentation and coding accuracy, provide coding analysis and comprehensive summary of findings – initiate HCC coding intervention with key practices to improve their coding accuracy.
• Analyze internal systems and platforms to identify and remedy issues that hinder complete encounter data capture.
• Prospective reviews of current conditions and suspect conditions
• Concurrent review/real time education support and feedback during patient face-to-face visit to ensure coding and documentation accurately captures patient health status
• Billing education/review to ensure all codes are captured on claim
• Monitor and track practice performance in the areas of:
• HCC Recapture
• Suspect Recapture
• RAF

Skills and Experience Required

• Proficient in Microsoft Excel and Word
• Public speaking
• Meeting facilitation
• Epic EMR experience preferred
• Proficient in Power Point
• Excellent organizational skills

Required Experience

• Professional medical coding credentials
• 1 year HCC coding and auditing (chart review) experience
• Proven history of project management and/or coordinating detailed projects or activities
• Has worked in a doctor’s office or experienced working with providers
• Ability to work independently and problem solve
• Ability to clearly communicate, both verbally and in written format
• Driver’s license and proof of auto insurance

Required Education

• Bachelor’s degree preferred plus two years’ experience in a healthcare setting
• AAPC/AHIMA Certification
• Additional Comments

Additional Comments

• Travel to physician practices and regional offices will be required on a weekly basis. With few exceptions, travel will be limited to the San Francisco Bay Area, Sacramento, and San Joaquin and will occur within normal business hours.

Salary Range

$64,480 - $81,740

Additional Information

Hill Physicians is an Equal Opportunity Employer

Job Type: Full-time

Pay: $64,480.00 - $81,740.00 per year

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