Risk Adjustment Coder (STX)

UHS•McAllen, TX

1d•Onsite

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Coder of Risk Adjustment will be responsible for accurate, compliant coding and documentation review to support Medicare risk adjustment and organizational compliance. The Coder performs post review production coding, medical record review abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection. The role also includes preparing charts for scheduled health assessments, identifying documentation and coding opportunities for provider review, and providing guidance on coding and guidance on coding and documentation requirements related to those charts. The Coder must be well grounded in sound medical coding practices. Knowledge of HEDIS data collection is required. This is an onsite position.

Requirements

High School Diploma, GED or equivalent required
Minimum one (1) year experience in CMS HCC risk adjustment coding required
Successful completion of coding certification program (CCS, CPC, CRC, or RHIT)
ICD-10 and CPT II coding proficiency
Must have the ability to meet 95% & above accuracy
Must have the ability to meet CPH expectations
Ability to effectively communicate in English, both verbally and in writing.
Proficient in Microsoft Office Suite, Word, Excel and Access
Excellent written and oral communication skills
Attention to the detail.
Must have the ability to work independently

Nice To Haves

Associates degree preferred
Insurance industry.
Knowledge of HEDIS data collection is preferred.

Responsibilities

Accurate, compliant coding and documentation review to support Medicare risk adjustment and organizational compliance.
Performs post review production coding.
Medical record review abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection.
Prepares charts for scheduled health assessments.
Identifies documentation and coding opportunities for provider review.
Provides guidance on coding and documentation requirements related to those charts.