Risk Adjustment Coder
About The Position
The Risk Adjustment Coder conducts thorough concurrent, prospective, and retrospective reviews of ambulatory medical record documentation to ensure accurate and complete capture of each 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, as well as coding, auditing, clinical documentation, and risk adjustment model guidelines. The coder may also participate in developing, presenting, and disseminating provider communications and 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) and medical records (EMRs), including the ability to navigate a variety of systems.
- 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 records 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, and coding, auditing, clinical documentation, and risk adjustment model guidelines.
- May participate in developing, presenting, and disseminating provider communication 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
Education Level
High school or GED
