by Ellen Johnston, RHIA, CRC
If you are currently employed in the risk adjustment field, you may be asked a recurring question by your family, friends, and others: What exactly do you do again? For those of you who have been in the risk adjustment area for many years, you probably have a carefully crafted explanation, but for newbies, you may be wondering what you have gotten yourself into. This article is here to help people who are in the field or who are just curious about the risk adjustment world to learn about opportunities available for HIM professionals.
Opportunities for Employment:
- Health Plans: Health Plans are a great place for risk adjustment professionals to look for employment. Most Medicare Advantage health plans will have a risk adjustment team that oversees their submissions to CMS, as well as coordinating chart requests and overseeing general compliance on providers and vendors. Risk adjustment coding professionals can contribute to the team in a unique way, as they are usually the most familiar with documentation standards/guidelines and can perform audits on providers as well as provide education.
- Vendors: There are multiple vendors that exist to assist health plans and health systems with proper code capture around risk adjustable conditions. Vendors employ risk adjustment coding professionals to review and code risk adjustable conditions (HCC’s). If you are looking for a more traditional coding position that involves risk adjustment, a vendor would be a good place to look.
- Accountable Care Organizations (ACO)/Clinically Integrated Networks (CIN): These organizations exist to assist providers in value-based care arrangements. This is done through care coordination, working to close quality gaps in care, and redocumenting existing chronic conditions throughout the year. A risk adjustment professional can add value to an ACO/CIN by acting as a subject matter expert and an educational resource for healthcare providers and other staff.
- Primary Care Providers/Physician Offices: If you are looking for a role where you are more integrated into the clinical team, this would be your opportunity. Primary care provider organizations and offices hire risk adjustment coding professionals to ensure that risk adjustable chronic conditions are accurately coded. These types of roles are vital to supporting healthcare providers in risk adjustment efforts to make sure that all appropriate gain share dollars are funneled back to the provider.
- Information Technology: This is a newer area for risk adjustment professionals. As providers are relying more heavily on their electronic health records to help with functionality around HCC capture, IT organizations will need the expertise of a risk adjustment coder to help leverage new software, both in the development stage and end user stage. This is a place to watch closely as more systems are being developed.
These are five of the most common areas of employment for risk adjustment coding professionals, although risk adjustment knowledge can be valuable in many areas such as data analytics, process improvement, finance, and much more. Just remember to not sell yourself short, and embrace your niche expertise that you possess as a risk adjustment professional. It really is a field with many opportunities!
About the Author
Ellen Johnston, RHIA, CRC is the current Director of Privacy & Security on the OHIMA FY 2021-22 Board of Directors. Ellen is the Program Manager of Risk and Coding Accuracy at Mount Carmel Health Partners.
