Risk Adjustment Coder

Cano Health•Miami, 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 claim and encounter documentation policies, and provides support for coding recommendations. The position reviews medical records for coding under CMS HCC categories, prepares charts and tracks patient information, submits encounters, works HCC suspect reports, and provides coding support and education to providers and care teams. It also supports audits, billing claims, quality improvement, and annual wellness visit scheduling follow-up. The coder researches coding questions for provider offices, keeps current with changing coding requirements, and provides weekly status updates to the Director. Travel to offices may be required for on-site chart reviews.

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 claims and encounters.
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 in a timely manner.
Research and address coding 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 coding knowledge.