Government Programs Risk Adjustment Coder

Role Overview

• Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
• Offer suggestions and assistance for improvement in departmental processes & other duties as assigned
• Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture
• Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health plan members
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented
• Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy, Completeness, specificity and appropriateness of diagnosis information
• Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality
• Maintains established work production standards
• Assumes responsibility for professional growth and development
• Participates in professional healthcare and community associations to keep abreast of current healthcare trends

Requirements

• High School Diploma or GED
• Coding education including understanding of proper guidelines and usage of ICD-9-CM, CPT and HCPCS
• RHIT
• Registered Health Information Technologist or CPC-P
• Certified Professional Coder (Physician) or CCS-P
• Certified Coding Specialist (Physician), and CRC-Certified Risk Adjustment Coding Credential required
• Nursing licensure is considered a bonus
• Prior HCC/HHS experience with Medicare Risk Adjustment with three (3) years’ experience in medical coding
• Familiarity with the CMS Medicare risk algorithm (CMS HCC) and the ACA risk algorithms (HHS HCC)
• Strong analytical skills
• Proficiency with Microsoft Word, Excel and PowerPoint or comparable software required

Benefits

• Medical, Dental & Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off
• Holidays
• Volunteer time off
• Incentive Plan
• Tuition Reimbursement
• Professional development opportunities