Risk Adjustment Coder

Cano Health•San Francisco, CA

About The Position

It's rewarding to be on a team of people that truly believe in making an impact! We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us. Job Summary The Risk Adjustment Coder III plays a vital role on the risk adjustment team, ensuring the accurate and efficient coding of medical diagnoses in accordance with risk adjustment models and payer programs. This position demands extensive expertise in Risk Adjustment coding, ICD-10-CM guidelines, and HCC coding. The ideal candidate will exhibit exceptional accuracy, strong analytical abilities, excellent verbal and written communication skills, and a thorough understanding of risk adjustment policies to support proper reimbursement and compliance for healthcare providers.

Requirements

High school diploma or equivalent.
5 years of experience in medical coding with a focus on risk adjustment or HCC coding.
Extensive knowledge of ICD-10-CM coding guidelines and risk adjustment methodologies.
Experience with medical record review, documentation guidelines, and auditing.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
Five (5) years prior medical coding experience (ICD-10, CPT, and HCPCS).
Expertise of Medicare Risk Adjustment methodology.
Excellent knowledge of ICD-10-CM coding conventions and guidelines.
Excellent communication skills, both written and verbal, for engaging with clinical teams, physicians, and management.
Strong analytical skills with attention to detail.
Ability to review and interpret medical records and clinical documentation effectively.
Ability to work independently and prioritize tasks in a fast-paced environment.
Demonstrated critical thinking and decision-making skills relative to clinical documentation.
Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing.
The associate is required to work at a personal computer as well as be on the phone for extended periods of time.
Must be able to stand, sit, walk and occasionally climb.
The incumbent must be able to work extended and flexible hours and weekends as needed.
Physical demands include ability to lift up to 50 lbs.

Nice To Haves

Associate's degree or certification in Health Information Management, Medical Coding, or related field is preferred.
Certified Risk Adjustment Coder (CRC) preferred.
Additional AAPC specialty certifications (CPMA, CDEO, etc.).
Flexibility to travel to clinical sites as needed

Responsibilities

Medical Coding and Documentation: Accurately assign ICD-10-CM codes for diagnoses from medical records, clinical notes, and encounter data, ensuring they are compliant with risk adjustment regulations.
Ensure complete and accurate coding to capture all relevant diagnoses for risk adjustment purposes, including HCC codes.
Review and analyze medical charts to identify gaps in coding and provide corrective coding where necessary.
Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one's actions.
Risk Adjustment Models & Compliance: Stay up to date with changes to risk adjustment models, including CMS-HCC, and any other relevant regulations or guidelines.
Ensure compliance with all CMS (Centers for Medicare & Medicaid Services) risk adjustment policies and coding standards.
Perform audits of documentation and coding to ensure risk-adjusted populations are appropriately captured and that all conditions are accounted for.
Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.
Data Quality & Accuracy: Maintain a high level of coding accuracy, consistently meeting departmental quality standards.
Identify trends in coding errors or missing diagnoses and collaborate with clinical and coding teams to address discrepancies.
Provide coding guidance to junior coders or team members and assist with training and development when needed.
Collaboration and Reporting: Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.
Work closely with clinical documentation improvement team, risk adjustment specialists, and quality and assurance coders to improve documentation and coding processes.
Participate in coding reviews and audits.
Provide feedback and insight into coding practices.
Assist in the preparation of reporting and documentation to support the organization's risk adjustment programs, strategy and quality improvement initiatives.
Education and Professional Development: Continuously update knowledge of medical coding practices, risk adjustment methodologies, and ICD-10-CM updates.
Participate in ongoing training and professional development opportunities to maintain coding certification and stay current with industry changes.
Actively mentor and assist lower-level coders or new team members in coding practices and procedures.