Risk Adjustment Coding and Documentation Specialist

Job Code: 28980

Position Summary

This position is responsible for facilitating the improvement in the overall quality, completeness, and accuracy of practice-based clinical diagnosis coding and documentation.

Responsibilities

• Verifies and ensures the accuracy, completeness, specificity, and appropriateness of risk adjustable diagnosis codes and clinical documentation based on services rendered

• Engages KCN clinicians and their staff by supporting and educating on pre-visit planning to include identifying severity of patient illness

• Improves the provider coding experience by ensuring KCN clinicians and their staff receive regular feedback regarding coded cases and opportunities for improved documentation

• Supports KCN practices by analyzing chart documentation related to clinical status of patient, current treatment plan, past medical history and identifies potential gaps in provider documentation

• Serves as a resource by independently educating KCN clinicians and their staff by identifying errors and issues related to diagnosis coding and documentation to bring about a positive network value program outcome

• Develops program improvement plans and training materials

• Suggests and educates appropriate solutions in accordance with nationally recognized coding guidelines

• Actively engages and collaborates with payer partners on coding recapture and resolution of diagnosis

• Utilizes software and population health application to collect, track, and communicate information related to diagnosis coding

• Collaborates with KCN Contracting, Analytics and Information System teams to discern appropriate interventions for identified performance opportunities through enhancements or optimization to data, reports and population health application

• Performs other related duties as assigned

• Familiar with standard concepts, practices, and procedures within the field

• Relies on experience and judgment to plan and accomplish goals

• Regular and predictable attendance is an essential job function

• Competent to meet age specific needs of the unit assigned

Requirements and Minimum Qualifications

• Graduate of a formal coding program or completion of a coding training course required

• Associate degree preferred

• Minimum 3 years' coding/medical record chart review experience in a healthcare setting required

• Previous Risk Adjustment Methodology and diagnosis coding experience required

• Coding certifications through AHIMA or AAPC; Outpatient Coding: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician, (CCS-P), or other related certification required

• Certification as Risk Adjustment Coder preferred

• Experience with Hierarchical Coding Category (HCC) Risk Adjustment Model preferred

• HCC diagnosis coding and clinical record(s) review process preferred

• Strong knowledge of CPT and ICD-10 coding and medical record documentation

• Proven history of project management and/or coordinating detailed projects or activities

• Strong written and verbal communication skills, including ability to establish and build strong relationships

Working Conditions

• Must be able to lift and move up to 10lbs

• Must be able to maintain a sitting position

• Typical equipment used in an office job

• Repetitive movements

About Kootenai Health:

Kootenai Health is a highly esteemed healthcare organization serving patients throughout northern Idaho and the Inland Northwest. We have been recognized with many accolades and distinctions, including being a Gallup Great Workplace, No. 1 Best Place to Work in Large Healthcare Organizations, and Magnet™ Status for Nursing Excellence. We pride ourselves on our outstanding reputation as an employer and a healthcare provider.

As your next employer, we are excited to offer you:

• Comprehensive medical coverage, including fully employer‑paid options for eligible full‑time employees, plus affordable plans for part‑time staff. Benefits begin on the 1st of the month following 30 days of employment.


• Dental, vision, life, and pet insurance, with telemedicine and wellbeing resources available to all employees


• Tuition assistance after 90 days to support your professional growth


• Retirement plans with pre‑tax and Roth options and employer matching from 3%–6%


• Competitive pay, plus night, weekend, and PRN shift differentials


• Award‑winning wellness program with coaching, financial wellness resources, and free or discounted access to fitness centers and premium wellbeing apps


• PerkSpot discounts providing access to thousands of exclusive deals in over 25 categories


• And an employee referral bonus program

Kootenai Health provides exceptional support for extraordinary careers. If you want to work on a high-quality, person-centered healthcare team, we can't wait to meet you!

Apply today!

Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, veteran status, or sex. Kootenai Health does not exclude people or treat them differently because of race, color, national origin, age, disability, veteran status, or sex.