Coding Specialist - Risk Adjustment

Minneapolis, Minnesota
Dec 12, 2017
Mar 16, 2018
Employment Status
Full Time

Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.




At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.



Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.




Position Description

This position is responsible to monitoring needs of the compliance oversight program to ensure that UCare's data submissions to government agencies for risk adjustment payments based on diagnoses are compliant with applicable laws, regulations and contract requirements.  Specific duties and responsibilities include:


Perform clinical validation reviews of medical records to ensure the accuracy of diagnostic coding and adequacy of clinical documentation.


Perform validation of diagnosis data submitted by external vendors.


Document review findings including inconsistent or incomplete documentation.


Participate in risk adjustment data validation audits by government agencies or outside audit vendors.


Assist in the maintenance of internal chart review guidelines to ensure the accuracy of diagnoses data captured and submitted to regulatory agencies.


Assess the need for provider education and assist in the development of educational materials related to compliant coding and risk adjustment practices.


Comply with official coding guidelines and integrate coding principals during reviews while maintaining HIPAA privacy.


Monitor annual changes related to ICD-10-CM codes and the risk adjustment models.


Maintain knowledge of risk adjustment regulatory requirements and serve as an internal resource for departments in implementing coding and process changes needed to meet compliance. 

Other projects and duties as assigned. 



Current and valid professional coding certification from an accredited institution.


Required Experience

Two years of progressive coding experience using ICD-9/ICD-10-CM, CPT and HCPCS.    One year experience with risk adjustment coding (HCC).  Knowledge of coding, billing and compliance across a broad range of specialties and experience working with Medicare coding requirements.  Experience in conducting audits and medical record reviews.

Preferred Experience

Experience with Data Validation audits.  Clinical coding experience.  Certified Risk Adjustment Coder (CRC).


UCare is proud to be a recognized Star Tribune Top Workplace for the 8th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.


As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

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