Medical Coder

Centrum Health•Doral, FL

About The Position

The Coding Coordinator is an integral part of ensuring outstanding clinical care for members and serves as a primary coding contact for compliance oversight, with a focus on accuracy and potential coding opportunities. The role also conducts secondary-level quality audits. Responsibilities include supporting risk adjustment coding audits, retrieving medical records, auditing vendor work, abstracting codes, and reviewing documentation to ensure ICD-10-CM codes are appropriately assigned and clinically supported. The Coding Coordinator tracks documentation improvement opportunities, maintains coding certifications and current knowledge of coding and regulatory requirements, meets quality and productivity standards, responds to coding questions, and ensures compliance with federal rules and regulations.

Requirements

Associate degree or bachelor's degree.
Three or more years of experience in Medicare Advantage and Commercial coding and risk adjustment.
Current coding certification through AAPC or AHIMA.
Extensive knowledge of risk adjustment and ICD-10-CM coding guidelines.
Extensive knowledge of Medicare Advantage and Commercial HCC models.
Proficiency in Microsoft Office products, including Word, Excel, and PowerPoint.
Medical record retrieval experience.
Strong written and verbal communication skills.
Strong attention to detail.
Vast knowledge of EMR systems, medical record review, and abstraction.
Ability to quickly learn and adapt to meet business needs.
Experience working with risk adjustment vendors.
Ability to work independently.
Ability to build relationships with office staff, physicians, and the market team.

Nice To Haves

Certified Risk Adjustment Coder (CRC).
HHS IVA RADV experience.

Responsibilities

Participate in risk adjustment coding audits, including vendor bi-directional chart chases, gap closure, and coding completeness.
Support medical record retrieval by contacting provider offices, obtaining records from EMR systems, and partnering with market nurses.
Conduct secondary-level quality audits of vendor work for RADV audits and other risk adjustment projects.
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are appropriately assigned and supported by clinical documentation.
Identify and track documentation improvement areas and participate in documentation improvement initiatives.
Maintain coding certifications and requirements and keep current with ICD-10 codes, CMS documentation requirements, and risk adjustment guidelines.
Meet and maintain coding quality and productivity standards.
Ensure compliance with all federal rules and regulations.
Research and respond to coding questions submitted through the coding inbox.
Perform other duties and responsibilities as assigned.