Risk Coder

Community Care Cooperative•Boston, MA

just now•Remote

About The Position

The Certified Risk Coder will be a part of an emerging coding team and coding service that performs retrospective and prospective risk coding reviews and completes provider training for a group of outpatient primary care practices across Massachusetts. In so doing, the Certified Risk Coder will use knowledge of appropriate coding, combined expertise in claims submission processes to improve the accuracy of documentation. This work ultimately leads to a greater understanding of the patient’s complexity while ensuring accurate risk adjustment for patient care. The Certified Risk Coder has experience in risk adjustment, outpatient primary care and/or behavioral health condition coding, billing compliance, and coding quality assurance protocols. The person in this role will report to the Manager, Risk Coding, and interface with an internal team of Practice Transformation Managers, as well as staff at FQHCs.

Requirements

0-5 years of risk coding experience
0-5 years of medical billing experience in an outpatient setting, preferably in primary care, pediatrics, or behavioral health
In-depth knowledge of medical terminology, anatomy, physiology, and disease process
Knowledge of electronic health record systems: Epic, NextGen, Centricity, and eCW preferred
Expertise in Medicaid and/or Medicare risk adjustment models
Billing compliance expertise required
Self-starter; exercises high degree of initiative, judgement, discretion and decision making to achieve objectives
Familiarity with Excel
Performs with great integrity and produces accurate work with close attention to detail, especially in the completion of final deliverables to internal and external stakeholders
Certified Risk Coding (CRC) Certification through AAPC required

Nice To Haves

Familiarity with the MassHealth ACO program
Familiarity with Federally Qualified Health Centers
Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Responsibilities

Serves as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth Risk Adjustment guidance
Completes record review with a high degree of familiarity with common EHRs, especially Epic, NextGen, Centricity, and eCW
Assists in the compilation and delivery of project reports and facilitates provider-facing interactions
Completes internal audits per quality assurance protocols
Facilitates allowable modifications to the bill to ensure accuracy, involving extensive interaction with FQHC billing and operations staff departments
Assists in chart preparation for providers in advance of appointments
Communicates with provider education team on observed trends to improve documentation
Utilizes population health reporting tools to assist in the identification of patients and conditions in need of review and improvement
Identifies opportunities for FQHC risk score improvement
Performs other duties as assigned