Government Programs Risk Adjustment Coder
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Job Description
Risk Adjustment Coder conducting compliance reviews and audits to ensure Medicare Advantage accuracy. Collaborating with healthcare providers and maintaining coding standards per CMS guidelines.
Responsibilities:
- Perform comprehensive review and oversight of medical records for Risk Adjustment compliance keeping with CMS and departmental guidelines with a 95%+ accuracy rate
- Offer suggestions and assistance for improvement in departmental processes & other duties as assigned
- Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture
- Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health plan members
- Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented
- Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy, Completeness, specificity and appropriateness of diagnosis information
- Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality
- Maintains established work production standards
- Assumes responsibility for professional growth and development
- Participates in professional healthcare and community associations to keep abreast of current healthcare trends
Requirements:
- High School Diploma or GED
- Coding education including understanding of proper guidelines and usage of ICD-9-CM, CPT and HCPCS
- RHIT - Registered Health Information Technologist or CPC-P - Certified Professional Coder (Physician) or CCS-P - Certified Coding Specialist (Physician), and CRC-Certified Risk Adjustment Coding Credential required
- Nursing licensure is considered a bonus
- Prior HCC/HHS experience with Medicare Risk Adjustment with three (3) years’ experience in medical coding
- Familiarity with the CMS Medicare risk algorithm (CMS HCC) and the ACA risk algorithms (HHS HCC)
- Strong analytical skills
- Proficiency with Microsoft Word, Excel and PowerPoint or comparable software required
Benefits:
- Medical, Dental & Vision coverage
- Retirement Plan
- Generous time off including Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Professional development opportunities
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