Population Health-Coding Specialist at Southeast Medical Group

Alpharetta, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Mar, 26

Salary

0.0

Posted On

23 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Coding, Documentation, Risk Adjustment, HCC, Medical Records Review, Education, Collaboration, Process Improvement, Analytics, Communication, Interpersonal Skills, EHR, Medical Terminology, Change Management, Quality Improvement, HIPAA Compliance

Industry

Hospitals and Health Care

Description

Description About Southeast Primary Care Partners: Southeast Primary Care Partners is a leading primary care organization dedicated to delivering high-quality, patient-centered care across the Southeast. As part of Southeast Medical Group (SEMG), we empower providers and teams to optimize health outcomes through innovative population health strategies. Join us in a collaborative environment where your expertise drives meaningful improvements in documentation, coding accuracy, and risk adjustment for better patient care and organizational success. Job Summary: As a key member of the Population Health team at Southeast Primary Care Partners, the Coding Specialist plays a vital role in ensuring SEMG providers adhere to best-in-class documentation and coding standards. Reporting to the Chief Population Health Officer and collaborating with Revenue Cycle Leadership, you will drive provider education, analyze performance metrics, and enhance coding accuracy to capture population risk effectively. This position offers opportunities for professional growth, including process improvement initiatives and staying ahead of industry regulations. If you're a detail-oriented coding expert passionate about quality improvement and clinician collaboration, this role is your chance to make a tangible impact on healthcare outcomes. Requirements Key Responsibilities: Conduct thorough reviews of medical records to ensure accurate coding, identify recapture opportunities, and flag suspect diagnoses for follow-up. Evaluate documentation against M.E.A.T. (Monitored, Evaluated, Assessed/Addressed, Treated) criteria to validate submitted diagnosis codes and recommend improvements. Partner with clinicians to query and recommend HCC diagnoses for chart addendums, fostering accurate and persistent coding practices. Collaborate cross-functionally with departments to implement coding updates, support risk adjustment programs, and contribute to HCC analytics through special projects. Lead or participate in process improvement initiatives, including the development of coding support tools, education materials, and training on risk adjustment best practices. Track, analyze, and report review results to inform targeted education for providers and clinical staff, aiming to enhance documentation specificity and HCC performance. Assist in implementing new coding and compliance regulations, ensuring SEMG stays current with emerging laws and guidelines. Maintain expertise in risk adjustment coding by researching guidelines, reading professional publications, attending seminars/webinars, and participating in medical organization meetings. Uphold professional credentials and handle confidential information in compliance with HIPAA standards. Perform additional duties as assigned to support Population Health objectives. Qualifications: Education and Experience: Associate's degree required; Bachelor's degree preferred (e.g., in Health Information Management, Nursing, or a related field). Proven experience in a professional coding setting or physician office, with direct responsibility for HCC/risk adjustment documentation auditing and coaching. Required: CPC (Certified Professional Coder) and CRC (Certified Risk Adjustment Coder). Preferred: CCDS (Certified Clinical Documentation Specialist) or equivalent. Knowledge, Skills, and Abilities: Strong familiarity with electronic health records (EHR) documentation methodologies and tools. Solid understanding of medical terminology, anatomy, and physiology. In-depth knowledge of third-party payer coding, billing, and reimbursement processes. Expertise in ICD-9/10-CM diagnosis coding, CPT-4, and HCPCS guidelines, with a focus on risk adjustment. Demonstrated success in change management, quality improvement initiatives, and driving measurable outcomes (e.g., improved coding accuracy rates). Proven ability to build strong relationships and establish credibility with physicians, clinicians, and cross-functional teams. Exceptional communication and interpersonal skills, with the ability to educate and influence effectively. Proficiency in Microsoft Office Suite (e.g., Excel for analytics, Word for reporting). Skilled in navigating resistance to change, problem-solving, and maintaining confidentiality under HIPAA.

Responsibilities

The Coding Specialist conducts thorough reviews of medical records to ensure accurate coding and collaborates with clinicians to enhance coding practices. They also track and analyze performance metrics to inform targeted education for providers.