Risk Adjustment Specialist/HCC Coder in Orange at Prospect Medical Systems

Date Posted: 10/23/2019

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Risk Adjustment Specialist

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The HCC Risk Adjustment Specialist will perform various audits as assigned by management to ensure physician documentation compliance. The Risk Adjustment Specialist will perform provider training sessions as requested by management as needed. Monitors and tracks success of training and clinician feedback through encounter audits and ensure documentation meets requirements for diagnosis assignment, based on official ICD guidelines. The HCC Risk Adjustment Specialist is responsible for training new staff members as requested by management, as well as, being a resource for other team members and management.

Job Responsibilities/Duties

  • Abstract pertinent information from assigned medical records using ICD-9-CM, CPT and/or HCPCS codes.
  • Provide management with input on provider performance from assigned audits and special projects
  • Document detailed chart audit findings including documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities in applicable audit tools on a daily basis
  • Ensure audit tools contain adequate evidence to support audit findings and reviews audit tools for accuracy and completeness.
  • Ensure all captured diagnoses is properly documented and supported within progress note according to CMS rules and regulations including but not limited to encounter date, legibility, proper provider signature and member identification requirements.
  • Report noncompliance issues detected through auditing.
  • Work with Medical Management to provide confidential feedback on special audits on as needed basis
  • Adheres to Official Coding Guidelines.
  • Research and provide courteous, accurate and timely response to inquires by providers as related to HCC Risk Adjustment projects and reports.
  • Assist with reconciliation of invalid diagnosis list supplied by Other Departments
  • Serve as a resource for internal and external customers to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements
  • Work with Health plans to ensure appropriate status information for member is reflected
  • Provide one on one provider training and audit sessions as requested by management
  • Attendance of additional provider training sessions based on departmental needs
  • Assist with chart retrieval from provider office based on departmental needs. This may include some travel with personal vehicle
  • Perform various audits and special projects as assigned by management


Minimum Education: A High School Diploma or Equivalent; BS/BA preferred.

Minimum Experience: Two to five (2 - 5) years experience in healthcare setting preferably related to HCC Risk Adjustment and/or chart auditing.

Req. Certification/Licensure: Must possess and maintain an AAPC or AHIMA certification — CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, RHIA.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Acute Care