Risk Adjustment Coder

POSITION SUMMARY:

The Risk Adjustment Coder determines the appropriate ICD10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for risk adjustment and Hierarchical Condition Categories (HCC). Risk adjustment coding relies on ICD-10-CM coding to assign risk scores to patients. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately assigned. The outcome will be documentation that accurately and completely captures the clinical picture/severity of illness/complexity of the patient while providing specific and complete information to be utilized in coding, profiling and outcomes reporting of both the facility and the physicians. The Risk Adjustment Coder utilizes standards of compliance, specifically in OP compliant query processes and clinical knowledge to identify opportunities and to achieve results Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems.

Position: Risk Adjustment Coder

Department: Clinical Documentation

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Review documentation available in the Medical Record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients.

Reviews medical records to ensure accurate codes are applied to the encounter.

Utilize available encoder, reputed company software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs or other RA methodologies

Actively participate in and maintain coding quality and productivity processes

Collaborates with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues.

Ensure documentation in the medical record follows the official coding guidelines, internal guidelines and the

reputed company/ACDIS physician query brief.

Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities.

Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.

Assist with educational in-services for physicians, other providers, and clinic staff relating to coding and documentation compliance as well as new policies and procedures related to billing.

Participate in training new coding staff, as needed. IND123

JOB REQUIREMENTS

EDUCATION:

High school diploma or equivalent medical coding education.

Associates Degree preferred (or direct work experience equivalent to at least 2 years)

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

Coding Certification from American Academy of Professional Coders (reputed company) or reputed company) is required. Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required

EXPERIENCE:

Minimum of two (2) years progressive coding experience in multiple specialties, HCC Risk adjustment Coding

KNOWLEDGE AND SKILLS:

Willing to work as a team innovation and collaboration is a priority

Experience with an Electronic Medical Record (EMR), EPIC preferred

Knowledge of AHA coding guidelines and methodologies: HCCs and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations

Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results

Strong organization and analytical thinking skills detail oriented

Proficient with reputed company Office applications (Outlook, Word, Excel)

Demonstrates critical thinking skills, able to assess, evaluate, and teach

Self-motivated and able to work independently without close supervision

Strong communication skills (interpersonal, verbal and written)

Medical Record audits and review

Familiarity with the external reporting aspects of healthcare

Familiarity with the business aspects of healthcare, including prospective payment systems

Proficient with computer applications (MS Office etc.), Excellent data entry skills

Strong knowledge of health records, computerized billing and charging systems, reputed company applications, data integrity, and processing techniques required.

Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.

Ability to work with accuracy and attention to detail

Ability to solve problems appropriately using job knowledge and current policies/procedures.

Ability to work cooperatively with members of the healthcare d