Coder, Medical Billing and Coding, Healthcare Administration

A small managed care company is looking for a Coder/CDI Specialist to focus on Medicare members.

Risk adjustment coding professional who has strong knowledge of HCC, RAF methodology, and CMS risk adjustment guidelines and is comfortable serving as a senior-level resource for coding quality and provider education.

• Audit and perform QC of coding team output for accuracy and compliance with HCC/ICD-10-CM guidelines
• Conduct second-level reviews and serve as an escalation point for complex charts and coding questions
• Identify documentation gaps and communicate directly with providers regarding documentation queries
• Educate physicians and clinical teams on documentation practices that support accurate risk adjustment coding
• Track coding errors, trends, and quality patterns and report findings
• Identify opportunities related to over/under-utilization and collaborate with teams and provider groups on solutions
• Support development of processes around right-coding, appropriate utilization, and closing care gaps
• Work independently as a senior-level coding and auditing resource

• Medicare Advantage / Managed Care experience required
• 3 years of Managed Care experience preferred
• Strong knowledge of HCC hierarchy, RAF methodology, and CMS risk adjustment guidelines
• Experience communicating directly with physicians and clinical teams
• Ability to identify coding and documentation gaps and recommend solutions
• Dual-eligible or FIDE-SNP experience is a plus