Risk Adjustment Coder

ChenMed

119d

About The Position

The Risk Adjustment Coder works in a collaborative effort directly with physicians and their office staff and other support departments to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the position is to collect and review documents to support the organization’s quality and risk adjustment initiatives, which results in improving quality of care.

Requirements

• High School Diploma or GED required.
• Coding Certificate required.
• APPC or AHIMA coding certified preferred.
• CRC (certified risk coder) is required, or minimum of 3-5 years’ experience in risk adjusting coding in lieu of certificate.
• Two (2) + years’ experience in a primary care environment is required.
• Strong knowledge of Microsoft Office Suite (Excel-basic mathematical formulas, charts, tables).
• Strong medical coding and third party operating procedures and practices.
• Knowledge of CPT/ICD-9 & 10 & Medical Terminology.

Responsibilities

• Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment Reviews of medical records.
• Verifies that diagnosis codes are supported by the documentation and ensure compliance with ICD-10-CM Guidelines for Coding and Reporting.
• Captures diagnosis codes for each chronic or major medical condition correctly.
• Queries providers for any diagnosis code that is unsubstantiated by the record to assess accuracy.
• Reviews clinical indicators and queries providers to capture the severity of illness of the patient.
• Conducts medical chart reviews to identify opportunities for improving individual member risk adjustment score accuracy.
• Provides feedback to internal clients on documentation and physician self-coding that do not meet quality standards.
• Identifies clinical coding and documentation trends and training needs to improve the quality of documentation.
• Attends all required meetings.
• Performs other duties as assigned and modified at manager’s discretion.

Benefits

• Great compensation
• Comprehensive benefits
• Career development and advancement opportunities
• Work-life balance

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees