Risk Adjustment Coder

Humana • Washington, DC

1d • $48,300 - $65,900 • Remote

About The Position

The Risk Adjustment Coder conducts quality assurance coding of medical records and ICD-10 diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Risk Adjustment Coder assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties that require independent initiative and judgment. The Risk Adjustment Coder ensures coding is accurate and properly supported by clinical documentation within the health record. Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes. Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records. Works on projects that may include making phone calls to providers. Works within broad guidelines with little oversight. Demonstrates a professional demeanor, strong work ethic, and is a reliable team player with a positive attitude. Utilizes effective written and verbal communication skills. Demonstrates Proficiency in using computers and relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools. Participates on special projects, in addition to daily responsibilities. Associates may be required to work mandatory overtime to meet business needs and ensure timely completion of operational tasks.

Requirements

• At least one of the certifications from AAPC or AHIMA are required from the list below: CPC or CPC-A - Certified Professional Coder (AAPC), COC - Certified Outpatient Coder (AAPC), CIC - Certified Inpatient Coder (AAPC), CRC - Certified Risk Coder (AAPC), CCA - Certified Coding Associate (AHIMA), CCS - Certified Coding Specialist (AHIMA), CCS-P - Certified Coding Specialist-Physician Based (AHIMA)
• Experience working in a goal-oriented environment that is production and quality driven.
• Must maintain annual continuing education requirements and remain in good standing with the coding credentialing body, AAPC or AHIMA.
• Must be able to work 40 hours a week, Monday – Friday, with the ability to work mandatory overtime as needed to support business needs.
• Must have a confidential work space in order to work effectively and independently without distractions.
• Proficient using relevant technology including the ability to navigate multiple software applications and perform tasks using digital tools.

Nice To Haves

• Proficient in the use of Microsoft Office systems Word and Excel
• Risk Adjustment Experience
• HCC Coding experience

Responsibilities

• Conducts quality assurance coding of medical records and ICD-10 diagnosis codes submitted to CMS and other government agencies.
• Ensures coding is accurate and properly supported by clinical documentation.
• Reviews medical records to report conditions that map to HCCs by reviewing medical record documentation and applying the appropriate ICD-10 diagnosis codes.
• Follows state and federal regulations as well as internal policies and guidelines while analyzing coding information and medical records.
• Works on projects that may include making phone calls to providers.
• Participates on special projects, in addition to daily responsibilities.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree