Risk Adjustment Coder
About The Position
The Coder, Risk Adjustment provides concurrent, prospective, and retrospective reviews of ambulatory medical record documentation to support accurate and complete capture of the patient’s clinical picture, severity of illness, and complexity. The role evaluates the accuracy and consistency of coded clinical data quality results and reports, following applicable federal, state, and county regulations and laws, coding and auditing requirements, clinical documentation guidelines, and relevant risk adjustment models. The Coder may also help develop, present, and distribute provider communications and participate in other clinical documentation activities.
Requirements
- High school diploma.
- At least 2 years of risk adjustment coding and/or auditing experience.
- Experience with electronic health records (EHRs) or medical records (EMRs), including the ability to navigate a variety of systems.
- Must hold one of the following certifications: Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Coding Specialist (CCS or CCS-P).
- Candidates hired without CRC certification must obtain it within the first year of employment.
Nice To Haves
- Prior experience with Medicare Managed Care (Medicare Advantage).
Responsibilities
- Review ambulatory medical record clinical documentation concurrently, prospectively, and retrospectively.
- Ensure accurate and complete capture of the patient’s clinical picture, severity of illness, and complexity.
- Evaluate the accuracy and consistency of coded clinical data quality results and reports.
- Follow applicable regulations, laws, coding and auditing requirements, and clinical documentation guidelines for risk adjustment models.
- May participate in developing, presenting, and disseminating provider communications and other clinical documentation activities.
Benefits
- Medical, dental, and vision insurance.
- 403(b) retirement savings plans with employer matching contributions.
- Flexible Spending Accounts.
- Commuter Flexible Spending.
- Career advancement and development opportunities.
- Paid Time Off and holidays.
- Paid CME days.
- Malpractice insurance and tail coverage.
- Tuition reimbursement program.
- Corporate employee discounts.
- Employee referral bonus program.
- Pet care insurance.
- The role may qualify for discretionary bonuses or incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
