Risk Adjustment Coding Specialist- Bilingual Spanish/English at USPI

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Full Time

Start Date

Immediate

Expiry Date

10 Jun, 26

Salary

0.0

Posted On

12 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Risk Adjustment Coding, ICD-10, CPT Codes, Bilingual Spanish English, Medical Record Interpretation, CMS Guidelines, HCC Documentation, Compliance, Provider Querying, Documentation Auditing, Revenue Cycle Management, Data Analysis, Clinical Documentation Integrity, Medical Terminology, Risk Adjustment Reimbursement, Critical Thinking

Industry

Description

Company Mission Duo Health is a new type of medical group designed around the needs of patients with chronic kidney disease and their physicians. Our unique Health Mobilization™ platform partners multidisciplinary care teams with community nephrologists and activates all the other clinicians, facilities and community organizations necessary to treat the whole patient on their own terms. Our team is comprised of leaders in value-based health care, technology and behavioral science who share a vision for advancing health equity one relationship at a time. Our interprofessional care teams, which include physicians, nurses, social workers, and patient navigators, provide high-touch and comprehensive care to a small panel of patients. Team collaboration is essential to our intensive, psycho-social model of care which includes assessment, medication management, social management, and behavioral health management. Job Description As the Risk Adjustment Coding Specialist, you will play a critical role in reviewing claims to ensure accurate coding and compliance with medical coding policies and guidelines. This role involves interpreting medical records, assigning appropriate ICD-10 and CPT codes, and ensuring that all coded data accurately represents the services provided. You will work closely with our Clinical Documentation Integrity Specialists, Medical Group Operations, Revenue Cycle Management and Compliance teams to leverage your coding and documentation expertise to foster improvements in the overall quality, completeness, and compliance of clinical documentation. You will serve as the subject matter expert on HCC documentation requirements and ICD-10-CM coding guidelines. Because this role supports Spanish‑speaking clinical teams and patients, the Risk Adjustment Coding Specialist must be fully bilingual in Spanish and English. This includes the ability to read and interpret Spanish‑language medical documentation, communicate with providers or team members in Spanish as needed, and ensure accurate translation of clinical concepts into compliant coding. Duties and Responsibilities * Conduct coding review on all provider documentation to assign the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines * Maintain knowledge of current coding guidelines with continuing education * Ensure coding accuracy to support risk adjustment reimbursement and maintain compliance with CMS regulations * Identify and report any potential areas of risk or non-compliance * Assist with training and education of providers and other team members as necessary * Assign appropriate CPT codes and modifiers and determine place of service based on documentation * Communicate provider documentation trends with the CDI team for provider education * Query providers directly as necessary to ensure that appropriate documentation appears in the medical record * Maintain a log of all documentation audits / reviews and conduct ongoing follow up activities and communication for uncompleted or unanswered queries * Maintain professional communication with provider teams * Assist with analysis, trending, and presentation of audit / review findings, outcomes, and issues * Ensure adherence to Duo Health’s coding guidelines and any necessary updates are shared across the teams * Develop a foundational understanding of existing EMRs and processes to surface risk opportunities * Assist in the Revenue Cycle Management workflow processes, such as denial and rejection management * Comply with all legal requirements regarding coding procedures and practices * Review and interpret Spanish‑language medical records and clinical documentation to ensure accurate ICD‑10 and CPT coding * Communicate in both Spanish and English with providers and other care team members when clarifying documentation, issuing queries, or supporting education * Provide feedback to the CDI team regarding Spanish‑language documentation trends that may impact coding accuracy or risk capture * Assist in translation or clarification of clinical documentation concepts to ensure proper understanding across bilingual care teams, while maintaining compliance standards * Provide coding guidance to Spanish‑speaking frontline care navigators as needed * Support translation of documentation‑related training materials for Spanish‑speaking providers and care teams Requirements * You have 5+ years of overall medical coding experience, and 3+ years of outpatient risk adjustment coding specific experience * Certified Risk Adjustment Coder, CRC, is required. Additional certifications preferred such as CPC, COC, CDEO, CPMA, CPB, CCS, CCS-P, RHIT, RHIA, CDIP, CCDS * Fluency in both spoken and written Spanish and English is required * Ability to read and interpret clinical documentation written in Spanish * Ability to communicate with clinicians and internal staff in both languages to resolve documentation questions or queries * Knowledge of medical terminology, physiology, pharmacology, and disease processes and related procedures * Knowledge of risk adjustment (HCCs), guiding principles, and reimbursement methodology * Previous experience in billing and E/M coding a bonus * You flourish in fast-paced environments, work independently, and can identify your own opportunities for success * You pay great attention to detail, are data-driven, and are tech-savvy * Excellent written and verbal communication skills and critical thinking skills * Strong ability to effectively build relationships and collaborate with coworkers and clinicians * Experience in Clinical Documentation Integrity (CDI) is preferred, including familiarity with query processes, documentation best practices, and collaboration with providers to improve accuracy and completeness of medical records. Working for Duo * 100% remote working environment * Competitive medical, dental and vision plans * Paid maternity and paternity leave * Access to free wellness & personal development courses * 401k plan with company matching * Paid holidays and unlimited PTO * A mission-driven approach to each and everything that we do, with an overall goal to improve health equity and health outcomes. #LI-Remote

Responsibilities

The specialist will review claims and provider documentation to assign accurate ICD-10 and CPT codes, ensuring compliance with medical coding policies and CMS guidelines for risk adjustment reimbursement. This role requires leveraging coding expertise to foster improvements in clinical documentation quality and serving as the subject matter expert on HCC documentation requirements, including interpreting Spanish-language medical records.