Risk Adjustment Coder
About The Position
Risk Adjustment Coder (RAC) supports lines of business from McLaren Health Plan, Inc. and McLaren Health Plan Community (McLaren) and is responsible for reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encounter information as it pertains to risk adjustment for both Medicare and Commercial/Affordable Care Act patient populations. The RAC possesses a strong background in reviewing medical records, identifying chronic conditions, and coding according to industry guidelines to ensure accurate and compliant documentation. The RAC works closely with internal departments and leadership to promote activities that support a successful risk adjustment program.
Requirements
- Associate’s degree in Health Information Management, Healthcare Business Services, or equivalent program with emphasis in coding or High School diploma with two (2) years of related experience.
- Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) credential.
- Two (2) years of hands-on experience in ICD-10-CM diagnostic coding, preferably experience in Risk Adjustment or HCC coding.
- Two (2) years’ experience in Medicare Risk Adjustment (MRA) HCC coding documentation guidelines, rules and regulations or the ACA equivalent.
Nice To Haves
- Five (5) years’ HCC coding and/or coding and billing experience.
- Two (2) years’ experience in Medicare Programs.
- Three (3) years’ experience in managed care.
Responsibilities
- reviewing medical records
- identifying chronic conditions
- coding according to industry guidelines
- identifying, collecting, assessing, monitoring, and documenting claims and encounter information as it pertains to risk adjustment for both Medicare and Commercial/Affordable Care Act patient populations
- promoting activities that support a successful risk adjustment program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
