Risk Adjustment Coder

Cano Health•Jupiter, FL

1d•Onsite

About The Position

The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The Risk Adjustment Coder is required to follow procedures and documentation policies regarding claim/encounter information and provide appropriate support to justify their recommendations.

Requirements

Two (2) years prior medical coding experience
Proficient in Microsoft Word and Excel
Strong organization and process management skills
Strong collaboration and relationship building skills
High attention to detail
Excellent written and verbal communication skills
Ability to learn new tasks and concepts
CPC, CPC-A or CCS-P, CRC Coding Certification

Nice To Haves

Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one’s actions.
Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.
Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.
Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places emphasis on the success of the medical centers and insurance companies.

Responsibilities

Review medical record information to identify all appropriate coding based on CMS HCC categories
Prepare the medical charts and track patient information via Excel spreadsheets.
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information
Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards
Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS
Monitor coding changes to ensure that most current information is available
Work HCC suspect reports
Accurately code and submit encounters on a timely basis
Researching and addressing code questions for multiple provider offices as directed
Update the Director on the status on a weekly basis
Notifies Patient Experience Manager if annual wellness visits for patients have not been scheduled.
Travel to offices as necessary to complete on-site chart reviews
Performs post-audits on assigned offices and notifies office contact when codes are not addressed for provider review.
Support and participate in process and quality improvement initiatives.
Assists with billing claims as assigned.