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 procedures and documentation policies, and provides support to justify coding recommendations. The position works with medical records, patient information, providers, care coordinators, and provider offices. It also requires keeping current with changing coding requirements through affiliated classes and individual learning. The job description notes that duties and responsibilities may change as business needs require.

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 extended and flexible hours and weekends as needed.
Ability to work at a personal computer and use the phone for extended periods.
Ability to stand, sit, walk, and occasionally climb.
Ability to lift up to 50 pounds.

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 entry for claim and encounter information.
Provide coding support, education, and training on documentation quality, level of service, and diagnosis coding in accordance 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 and ensure current information is available.
Work HCC suspect reports.
Accurately code and submit encounters on time.
Research and address code questions for multiple provider offices as directed.
Update the Director on status weekly.
Notify the Patient Experience Manager when 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.