Sr Risk Adjustment Coder

Stanford Health Care • New York, NY

91d • $44 - $57

About The Position

The Senior Risk Adjustment Coder will perform code audits and abstraction in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The HCC Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including but not limited to Medicare Advantage Risk Adjustment.

Requirements

• High school diploma or GED equivalent; Bachelor's Degree preferred.
• 5+ years of work experience in a risk adjustment program supporting and communicating with clinicians.
• Demonstrated knowledge of regulatory billing and coding guidelines.
• Understanding of the professional revenue cycle preferred.
• Knowledge of CPT, HCPCS and ICD-10 codes and rules.
• Ability to analyze and develop solutions to complex problems.
• Ability to perform research regarding complex coding and regulatory guidelines.
• Ability to work effectively both as a team player and leader.
• Ability to apply judgment and make informed decisions.
• Ability to foster effective working relationships and build consensus.
• Ability to make effective oral presentations and prepare concise written reports.
• Ability to plan, organize, prioritize, work independently and meet deadlines.
• Knowledge of computer systems and software used in functional area.
• Knowledge of local, state and federal regulatory requirements related to areas of functional responsibility.

Nice To Haves

• CPC - Certified Professional Coder.
• CRC - Certified Risk Adjustment Coder.
• CCDS - Certified Clinical Document Specialist.

Responsibilities

• Perform prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing.
• Review medical records to ensure accurate HCC coding and identify opportunities for recapture and suspect diagnoses.
• Evaluate medical records to verify that M.E.A.T criteria support the submitted diagnosis codes.
• Inquire with clinicians the recommended HCC diagnosis for chart addendum.
• Collaborate with other departments to address coding updates and support risk adjustment programs.
• Track and report review results that will be used to develop education and training materials on risk adjustment coding and/or documentation best practices.
• Assist with the implementation of emerging coding and compliance laws and regulations and assist with implementing privacy policies.
• Maintain current knowledge of risk adjustment coding guidelines by conducting research, reading professional publications, and maintaining professional networks.
• Attend coding seminars, webinars, and medical organization meetings.
• Perform other duties as assigned and participate in organization projects as assigned.

Benefits

• Base Pay Scale: Generally starting at $44.13 - $57.36 per hour.
• Equal Opportunity Employer.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees