Risk Adjustment Coder

Cano Health•Jupiter, FL

About The Position

The Risk Adjustment Coder identifies, collects, assesses, monitors, and documents claims and encounter coding information related to Clinical Condition Categories. The role verifies the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered, follows applicable procedures and documentation policies, and provides support for coding recommendations. The position works with primary care providers, care coordinators, and multiple provider offices, and may travel to offices for on-site chart reviews. Coding requirements may change, so the role requires participation in affiliated classes and individual efforts to maintain current knowledge.

Requirements

Two years of prior medical coding experience.
Proficiency 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, CCS-P, or CRC coding certification.
Ability to work at a personal computer and use a phone for extended periods.
Ability to stand, sit, walk, and occasionally climb.
Ability to work extended and flexible hours and weekends as needed.
Ability to lift up to 50 lbs.

Responsibilities

Review medical records to identify appropriate coding based on CMS HCC categories.
Prepare medical charts and track patient information using Excel spreadsheets.
Complete required paperwork, documentation, and system entries for claim and encounter information.
Provide coding support, education, and training on documentation quality, level of service, and diagnosis coding consistent with established 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 current information is available.
Work HCC suspect reports.
Accurately code and submit encounters on a timely basis.
Research and address code questions for multiple provider offices as directed.
Update the Director on status weekly.
Notify the Patient Experience Manager if patients’ annual wellness visits have not been scheduled.
Travel to offices as necessary to complete on-site chart reviews.
Perform post-audits on assigned offices and notify office contacts when codes have not been addressed for provider review.
Support and participate in process and quality improvement initiatives.
Assist with billing claims as assigned.
Participate in affiliated classes and make individual efforts to maintain current knowledge of changing coding requirements.