Risk Adjustment Coder-8

ChenMed

18h•Hybrid

About The Position

ChenMed is a unique and rapidly expanding primary care provider focused on transforming healthcare for seniors. The company is family-owned and physician-led, committed to delivering superior health care to moderate-to-low-income seniors. Their vision is to positively change American healthcare through primary care innovation for the neediest populations, providing a convenient, patient-centered environment that fosters enduring relationships between doctors, staff, and patients, and delivers superior outcomes and a compassionate experience. The Risk Adjustment Coder works collaboratively with physicians and their office staff to review medical records and clinical documentation. The primary goal is to identify appropriate risk adjustment codes and quality gap closure opportunities, collecting and reviewing documents to support the organization’s quality and risk adjustment initiatives, ultimately improving the quality of care for their members. ChenMed aims to create a healthcare system specifically for their patients' needs through dedicated doctors, a supportive team, and customized technology, achieving value through scalable innovation, resourcefulness, and accountability. Their patient promise is to provide coordinated healthcare and well-being, treating patients like family.

Requirements

Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease processes.
Demonstrated ability to utilize a variety of electronic medical records systems.
Ability to manage significant work load, and to work efficiently under pressure meeting established deadlines with minimal supervision.
Strong time management skills.
Excellent written and oral communication for representation of clear and concise results.
Strong follow-up skills & organizational skills required.
Must possess high degree of accuracy, efficiency and dependability.
High School Diploma or GED required.
Coding Certificate required.
CRC (certified risk coder) is required, or minimum of 3-5 years’ experience in risk adjusting coding in lieu of certificate.
Two (2) + years’ experience in a primary care environment is required.
Strong knowledge of Microsoft Office Suite (Excel-basic mathematical formulas, charts, tables).
Strong medical coding and third party operating procedures and practices.
Knowledge of CPT/ICD-9 & 10 & Medical Terminology.

Nice To Haves

APPC or AHIMA coding certified preferred.

Responsibilities

Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment
Reviews of medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether: The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
The diagnosis codes for each chronic or major medical condition have been captured correctly.
Any diagnosis code that is unsubstantiated by the record should be queried to provider and assess to accuracy.
Reviews for clinical indicators and query providers to capture the severity of illness of the patient.
Conducts medical charts to identifying opportunities for improving individual member risk adjustment score accuracy.
Provides feedback to internal clients on: Examples of documentation and physician self-coding that do not meet quality standards.
Examples of missed operations missed opportunities.
Examples of clinical that ensure quality and timely care of our members as well as correct reimbursement.
Identifies clinical coding and documentation trends and training needs to improve the quality of documentation to reflect our patients’ health data.
Attends all meetings as required.
Other duties as assigned and modified at manager’s discretion.