Value Based Coder II

Baylor St. Luke’s Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke’s Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart® Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke’s also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role
focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk-adjusting conditions and supporting provider documentation improvement.

1. Comprehensive Record Review & HCC Expertise: Independently review patient medical record information via population health tools on both a retroactive and prospective basis to identify, assess, monitor, and review network coding opportunities as it pertains to risk adjustment and
HCC. Validate the accuracy and completeness of HCC documentation and coding.
2. Advanced Documentation Improvement & Education: Analyze clinical documentation across the network to identify patterns, trends, and opportunities for improvement related to HCC capture. Develop and deliver effective education materials and tools to help network providers improve
clinical documentation and support Hierarchical Condition Category coding capture. Provide targeted provider 1:1 education on documentation best practices, HCC guidelines, and risk adjustment principles.
3. Compliance & Regulatory Insight: Continuously monitor and interpret evolving HCC coding guidelines, CMS regulations, and compliance trends within the risk adjustment landscape, applying this knowledge to daily coding and education efforts. Champion a culture of compliance by advocating for best practices and providing robust provider support to ensure CommonSpirit adheres to all federal and coding guidelines pertaining to HCC and risk adjustment. Safeguard medical records and preserve the confidentiality of personal health information through adherence to all relevant policies (release of medical record information, record retention, HIPAA privacy and security).
4. Process Improvement & Collaboration: Actively participate in network performance improvement initiatives, offering insights and solutions based on coding expertise. Collaborate with providers and office staff to address documentation deficiencies and coding gaps.

Required Education & Experience

● Bachelor’s degree in healthcare or equivalent work experience and/or 5 years of related job or industry experience in lieu of degree
● Certified Professional Coder (CPC) from AAPC, OR Certified Coding Specialist (CCS) from AHIMA, OR Certifed Risk Adjustment Coder (CRC) from AAPC

● 2+ years of experience in outpatient coding
● 2+ years focused on risk adjustment and HCC principles.

● Advanced knowledge of CPT and ICD-10 coding, with significant expertise in HCC coding guidelines and risk adjustment models.
● Strong understanding of federal and state guidelines on all coding systems and sponsored programs.
● Proficiency in developing and delivering educational content.
● Effective interpersonal, communication, and presentation skills (both verbal and written).
● Ability to manage multiple priorities and work independently.
● Computer literacy in medical information systems, records management software, and encoder software.