Risk Adjustment Coder

It's rewarding to be on a team of people that truly believe in making an impact!

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.

Job Summary The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The Risk Adjustment Coder is required to follow procedures and documentation policies regarding claim/encounter information and provide appropriate support to justify their recommendations.

Duties & Responsibilities

Essential Duties & Responsibilities Review medical record information to identify all appropriate coding based on CMS HCC categories

Prepare the medical charts and track patient information via Excel spreadsheets.

Complete appropriate paperwork/documentation/system entry regarding claim/encounter information

Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards

Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARSMonitor coding changes to ensure that most current information is available

Work HCC suspect reports

Accurately code and submit encounters on a timely basis

Researching and addressing code questions for multiple provider offices as directed

Update the Director on the status on a weekly basis

Notifies Patient Experience Manager if annual wellness visits for patients have not been scheduled.

Travel to offices as necessary to complete on-site chart reviews

Performs post-audits on assigned offices and notifies office contact when codes are not addressed for provider review.

Support and participate in process and quality improvement initiatives.

Assists with billing claims as assigned.

Additional

Duties & Responsibilities Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Due to the nature of this position, it is understood that coding requirements are expected to change;

therefore, participation in affiliated classes and individual efforts to maintain current knowledge of these changes is required.

Education & Experience Two (2) years prior medical coding experience

Proficient in Microsoft Word and Excel Strong organization and process management skills

Strong collaboration and relationship building skills

High attention to detail

Excellent written and verbal communication skills

Ability to learn new tasks and conceptsCPC, CPC-A or CCS-P, CRC Coding Certification Knowledge, Skills & Proficiencies Builds Trust:
Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one’s actions.

Pursues Excellence:
Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.

Executes for Results:
Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.

Collaborates:
Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places emphasis on the success of the medical centers and insurance companies.

Job Requirements

Physical Requirements This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs.

The physical demands described here are representative of those that must be met by an employee to…