Medical Risk Adjustment Coder- VBC

Orlando Health•Winter Park, FL

2d•Onsite

About The Position

The Medical Risk Adjustment Coder supports the physician practices and the Care Coordination Department with Coding Improvement activities using various clinical data systems.

Requirements

High School Diploma or equivalent.
Must maintain current one of the following: Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC)
Prior HCC/HHS experience with Medicare Risk Adjustment with two (2) years’ experience in medical coding.
Computer literate with skills in Windows, Microsoft Word, Microsoft PowerPoint, Microsoft Excel.
Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with providers.

Responsibilities

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 measures.
Demonstrates analytical and problem-solving ability in the process of reviewing submitted diagnosis codes, comparing to actual services provided to the patient, and communicates appropriate feedback to providers and billing personnel.
Performs analysis and focused chart reviews for targeted provider education training projects.
Assists in the acquisition, development and distribution of coding and documentation improvement educational materials.
Provides articles for the quarterly coding newsletter.
Facilitates collection, validation, distribution and follow-through support of monthly and quarterly HCC coding reports for all providers participating in the Managed Medicare Program and Accountable Care Organization Programs.
Places emphasis on compliance with Risk Adjustment procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
Coordinates data collection and aggregation on a variety of focused audits and HCC coding capture projects.
Validates the results of payer audits and translates findings into educational opportunities and tools to optimize revenue recovery.
Offers support in the Care Coordination Department, focusing on provider and staff education.
Facilitates ongoing quality metrics monitoring & assists with providing quarterly quality metrics reports for each PCP.
Performs data validation and integrity functions in a variety of systems pertaining to patient care, clinical documentation, charge entry & billing, and payer claims management.
Documents and reports activities regarding program status.
Reviews, analyzes and modifies data as necessary to meet both internal and external customer needs.
Works with clinical staff to analyze reports and collaboratively identify improvement opportunities.
Monitors quality, cost and efficiency on a recurring basis.
Remains available when needed to attend Managed Medicare meetings, record minutes, and translate meeting outcomes into action plans that yield measurable results.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
Maintains compliance with all Orlando Health policies and procedures.
Maintains established work production standards.
Assumes the responsibility for professional growth and development.
Ability to work independently in a time-oriented environment.
Participates in professional healthcare and community associations to keep abreast of current healthcare trends is expected.