Risk Adjustment Coder

Anew Health is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of Exact Care and Tabula Rasa Health Care, we provide a suite of solutions that includes comprehensive pharmacy services;

full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

Job Details

We are seeking a Professional Remote Medical Coder who will apply his or her technical and specialized expertise to help healthcare programs remain compliant with government regulations while identifying opportunities for increased financial success. The Professional Medical Coder will work from his or her home office to review, analyze, and code diagnostic and procedural information from medical records that determine payments to our clients.

The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement. The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

Responsibilities

• Perform medical record reviews and use coding principles to code to the highest specificity and comply with CMS and HIPAA regulations as well as company goals and policies.
• Perform Quantitative and Qualitative analysis of paper and electronic medical records for completeness, consistency and accuracy.
• Perform risk adjustment data validations using AHA coding guidelines.
• Interact with clients and co-workers to communicate value added information, make improvements and maintain strong partnerships.
• Be a constant learner, performing research and staying abreast of updates to remain top in his/her field.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

Qualifications

These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

• Possess valid Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association, Certified Professional Coder (CPC) designation, Certified Professional Coder Apprentice (CPC-A) designation or CCA designation with at least one year of coding experience. Being a Registered Health Information Administrator (RHIA) is a plus.

Experience

• Possess at least 6 months experience coding ICD-10 CM.
• Have experience with MS Word, Excel, PowerPoint, and be comfortable learning and becoming an expert on new and proprietary software.

Skills & Abilities

• Have strong written and verbal communication skills, including propensity to establish and build strong relationships.
• Take initiative to establish priorities, coordinate work activities and perform multiple and complex tasks while working independently and with minimal supervision in a remote setting.
• Be detail…