Risk Adjustment Coder

Suvida Healthcare•Dallas, TX

About The Position

The Risk Adjustment Coder coordinates and supports prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding. The role translates, inputs, extracts, and validates medical record data, helping improve documentation and coding accuracy and supporting the primary care team in delivering high-quality preventive care. The coder reviews patient records, audits documentation and coding, works with physicians and office staff, obtains records for review and audits, and provides education and feedback to providers. The position includes onsite visits to provider practices and requires meeting daily production goals and maintaining an average accuracy rate of 95% consistently.

Requirements

High school diploma or associate degree required.
At least 3 years of ICD-10 coding experience.
At least 3 years of Medicare risk adjustment coding experience.
At least 2 years of prospective and concurrent risk adjustment retrospective review experience.
At least 1 year of provider education experience.
At least 1 year of CPT and E&M coding experience.
At least 1 year of outpatient primary care coding experience.
CPC, CPMA, CRC, CCS-P, CCS, RHIA, or RHIT certification required.

Nice To Haves

Clinical education such as RN, LVN, LPN, Foreign Medical Graduate, or Pharmacist.
Elation EMR experience.
Bilingual Spanish.

Responsibilities

Review available patient medical records, including histories and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries, and other available records.
Determine whether diagnosis codes are supported by documentation and comply with coding and reporting guidelines (M.E.A.T).
Implement pre-visit and post-visit audits with assigned providers to capture documentation and coding accurately at the greatest level of specificity.
Build and maintain working relationships with physicians and office staff.
Maintain frequent touchpoints with assigned providers and schedule chart-review meetings.
Help obtain medical records from internal and external providers to ensure accurate documentation and support Health Plan audits.
Ensure compliance with applicable Federal, State, and/or County laws and regulations related to risk adjustment coding and documentation.
Educate physicians and supporting office staff on billing and documentation policies and procedures, including conflicting, ambiguous, or nonspecific documentation.
Identify missing documentation and coding opportunities, incorrect coding, and compliance trends; analyze and investigate suspected problems and bring them to the manager's attention.
Visit providers onsite at their practices to provide education and feedback based on chart reviews.
Meet daily production goals and consistently average a 95% accuracy rate.
Use outpatient primary care coding and medical record review skills.
Suggest and educate providers on correct CPT, HCPCS Level II, ICD-10-CM, and modifier coding.
Perform other duties as assigned.