Risk Adjustment Coder

Role Overview

• Determine the appropriate ICD10-CM diagnoses codes based on clinical documentation
• Review retrospective medical record documentation
• Ensure that the codes are appropriately assigned
• Collaborate with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues
• Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements
• Assist with educational in-services for physicians and other providers regarding coding and documentation compliance as well as new policies and procedures related to billing.
• Participate in training new coding staff, as needed.

Requirements

• High school diploma or equivalent medical coding education
• Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required
• Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist
• Outpatient or Certified Documentation Expert Outpatient (CDEO)
• Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required
• Minimum of two (2) years progressive coding experience in multiple specialties, HCC Risk adjustment Coding
• Experience with an Electronic Medical Record (EMR), EPIC preferred
• Knowledge of AHA coding guidelines and methodologies: HCC’s and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations
• Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results
• Strong organization and analytical thinking skills – detail oriented
• Proficient with Microsoft Office applications (Outlook, Word, Excel)
• Medical Record audits and review
• Familiarity with the external reporting aspects of healthcare
• Familiarity with the business aspects of healthcare, including prospective payment systems.

Benefits

• Medical
• Dental
• Vision
• Pharmacy
• Flexible Spending Accounts
• 403(b) savings matches
• Paid time off
• Career advancement opportunities
• Resources to support employee and family well-being