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Salary: USD 54,800 - 73,250 / annual
Lumeris is seeking a Risk Adjustment Coding Accuracy Specialist to support healthcare documentation and coding accuracy initiatives for their clients. In this role, you will review provider medical records to identify opportunities for complete and accurate documentation and coding, supporting both pre-visit planning and post-visit coding programs. You'll identify chronic conditions for provider review, query providers to ensure documentation completeness, and partner with clinical and administrative staff to enhance understanding of Clinical Documentation Improvement program goals aligned with Risk Adjustment strategic objectives.
Key responsibilities include conducting medical record reviews for coding accuracy validation, maintaining expertise in ICD-10 coding guidelines and CMS-HCC risk adjustment models, collaborating across internal teams to meet client-specific goals, overseeing coding vendor work, and communicating findings to support Senior Auditors. You'll work in a matrix environment, requiring strong cross-functional collaboration skills and the ability to manage complex documentation and coding initiatives.
Required qualifications include a Bachelor's degree, 3+ years of ICD-10 outpatient coding and provider query experience, strong knowledge of ICD-10-CM coding guidelines, E/M, CPT/HCPCS, and CMS-HCC risk adjustment models, and CPC certification. Preferred qualifications include CPC-I or CRC certifications and an Associate degree or technical school background. You should demonstrate excellent verbal and written communication skills, proficiency with Microsoft Office, and the ability to work effectively in collaborative, matrix-based corporate environments.
