Edifecs Careers

Risk Adjustment Coding Advisor – Temp Position

Overview

Edifecs is seeking a Risk Adjustment Coding Advisor to join our Risk Adjustment team. This role involves leveraging clinical, coding, documentation, and analytical skills to develop technology solutions for Health Plans and Providers. The ideal candidate will possess a unique combination of technical ability, clinical experience (including ICD-10 coding and clinical documentation), and problem-solving skills. This is temporary 3 – 4-month position.

What you will do:

• Recommend process improvements to enhance coding quality goals and outcomes.
• Validate and troubleshoot Natural Language Processing (NLP) outputs from clinical documentation.
• Oversee coding projects, including training third-party coding vendors and reviewing coding guidelines.
• Develop content for training guides and webinars.
• Conduct training and education related to audit outcomes.
• Perform quality assurance tasks for Informatics releases.
• Collaborate with Informatics Engineers to analyze client data.
• Work with the Product Management team to integrate Informatics deliverables into existing products.
• Develop business requirements and create user workflows.
• Articulate the customer value derived from products.
• Prepare educational videos and content as needed.
• Review and understand customer coding guidelines.
• Perform user acceptance testing for products.
• Provide timely product support in collaboration with the Customer Success team.
• Integrate technology solutions with third-party vendors for customers.
• Support subject matter expert conversations with existing and new customers.
• Perform and validate code abstraction and conduct coding quality audits of medical records to ensure accurate ICD-10-CM code assignment.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.

What you will bring:

• Medical coding certification (RHIA, RHIT, CCS, CPC, or CRC) with 3-5 years of coding and auditing experience.
• Bachelor’s degree or equivalent experience.
• LPN or RN with coding/documentation skills/certification is a plus.
• Working knowledge of risk adjustment models including CMS-HCC, HHS-HCC, and CDPS.
• Experience with standardized clinical terminologies such as ICD-10 and CPT-4.
• Excellent knowledge of coding guidelines and updates; knowledge of risk adjustment and HCC coding.
• Strong understanding of anatomy, physiology, disease processes, and medical terminology.
• Familiarity with standard clinical terminologies like SNOMED and RxNORM (preferred).
• Experience with RADV or RAC audit processes (preferred).
• Experience with at least one Electronic Health Record (EHR) system (e.g., Epic, Athena, Centricity, Cerner).
• Experience in a healthcare IT environment.
• Strong analytical, troubleshooting, and problem-solving skills.
• Willingness to learn new technical skills such as database querying.

Note: The expected hourly pay range for this position is $40-$45/hour. Hourly pay offered may vary depending on location, job-related knowledge, education, and experience. 

About Edifecs

Edifecs provides market-leading technology to its payer and health system customers, which serve nearly 300 million people in the U.S. healthcare market. For over 25 years, Edifecs has enabled customers to unlock greater value with their healthcare data management platform which includes its Best in KLAS healthcare interoperability cloud solution. Edifecs’ healthcare SaaS solutions, available on both public and private clouds, serve as the foundation that eliminates stakeholder friction to overcome healthcare’s biggest challenges, including accelerating value-based payment adoption and obtaining more complete and accurate care funding for alternative payment models. Edifecs’ solutions are powered by AI that incorporates generative AI and LLMs, natural language processing, and machine learning, to provide deeper insights into patients, populations, and business processes. As new standards and regulations continually emerge from government agencies, Edifecs is a proven partner to support its customers road to “evergreen” compliance. Edifecs customers include 24 of the 25 top commercial health plans in the country, 29 of the 52 Medicaid programs, and 6 out of 10 of the largest health systems.

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, sex, religion, national origin, protected veteran status, disability status, or any other characteristic protected by law.

Edifecs will provide reasonable accommodation to individuals with disabilities who need assistance applying for a job.  Please contact [email protected] for more information.