Risk Adjustment Senior Coding Specialist

Bright Health

Denver, CO, US


Bright Health will deliver a smarter, more connected healthcare experience. The company’s affordable health insurance plans, exclusive partnerships with leading health systems, and simple, friendly approach to technology are reshaping how people and physicians achieve better health together. Today, Bright Health provides health insurance to individuals in Colorado and will be expanding to other geographies and product offerings in 2018.

We are united by a common vision: To deliver the best healthcare experience by putting brilliant minds, empathetic hearts and personalized technology to work to create meaningful relationships between our members and Care Partners.

Our mission? Making Healthcare Right. Together.


The Bright Health Optimization Team is a key driver of Bright Health’s success as it strives to continue offering high-quality clinical care for our members. As the Risk Adjustment Sr. Coding Specialist, you will serve as the Subject Matter Expert (SME) for all risk adjustment medical coding and documentation related matters. You will be responsible for developing and maintaining Bright Health’s risk adjustment coding program, which includes documentation, coding, and training guidelines. You will focus on projects related to medical record reviews, diagnosis and provider coding, documentation and training education, internal audits, and CMS/HHS risk adjustment audits. You will collaborate regularly with the Risk Adjustment, Health Optimization, and Quality/HEDIS teams.


Develop and manage an internal and provider risk adjustment coding and documentation education program
Develop and manage an internal process for all RADV audits to ensure accurate data is provided to CMS and HHS
Develop and manage an internal coding validation process to optimize the submission of complete diagnoses to CMS and HHS from audits performed by internal coders, vendor partners, and Care Partners
Provide analysis and produce reports on trending to identify high risk providers and coding opportunities for the Risk Adjustment, HEDIS, and Health Optimization team
Supervise Corporate Coding Specialists to reach optimal productivity with 95% IRR
Advise leadership on coding changes, regulations, and submission requirements related to coding, documentation, and RADV audits
Monitor yearly updates and changes of ICD-10-CM and AHA’s Coding Clinic guidelines
Maintain all coding certifications and requirements
Participate in cross functional work to establish internal and external processes, procedures, and communication plans
Assist with risk adjustment audits and other projects related to documentation and coding, including chart retrievals, chart reviews, coding validation, analytics, trending and reporting

You are an experienced coder looking to use your expert-level skills to develop and manage new coding processes. You are seeking an opportunity to build something new and directly contribute to Bright Health’s high-quality clinical care. You have 5+ years of progressive coding experience using ICD-9-CM/ICD-10-CM, CPT-4 and HCPCS, and 4+ years of experience with Medicare and/or Marketplace (ACA). You have designed and conducted provider education training and monitored outcomes. Additionally, you have experience in designing and/or conducting audits and record reviews with actions plans, including RADV audits. You have an extensive knowledge of coding, billing, and compliance across a broad range of specialties. You have a proven ability to develop, document, and maintain operational policies and procedures. You can offer a combination of technical, creative, and people skills that make you an irreplaceable asset.
An AHIMA or AAPC coding certification is required

Like others on our team, you are humble, mature, and check your ego at the door. You are brave and always challenge the status quo, but respectful and have an open mind. You thrive in collaborative environments, and you are excited to take ownership at an early stage of our company.

*This position is located in either Denver, CO or Minneapolis, MN

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