Cert. Risk Adjustment Coder

About the Role

The Certified Risk Adjustment Coder accurately codes, sequences, abstracts, and audits outpatient medical records according to ICD-10-CM, CPT coding guidelines, and abstracts supported HCC (Hierarchical Condition Category Coding) diagnosis codes that are clinically significant in a risk adjustment payment model. This role ensures accurate and timely reimbursement and populates statistical databases. Responsibilities include querying physicians for clarification on documentation and performing duties within approved practices, exercising independent judgment within pre-determined guidelines.

Responsibilities

• Accurately code, sequence, abstract, and audit outpatient medical records according to ICD-10-CM and CPT coding guidelines.
• Abstract supported HCC diagnosis codes that are clinically significant in a risk adjustment payment model.
• Query physicians for clarification on documentation.
• Ensure accurate and timely reimbursement and populate statistical databases.
• Perform duties within approved practices, exercising independent judgment within pre-determined guidelines.

Requirements

• Two years of outpatient coding experience required.
• Experience with Hierarchical Condition Coding and Auditing preferred.
• Certified Professional Coder (CPC) or Certified Coding Specialist- Physician based (CCS-P) required.
• Certified Risk Adjustment Coder (CRC) required.
• High School diploma or equivalent required.
• Completion of coding program of study preferred.

Qualifications

• Knowledge of Health Information Systems practices, procedures, and guidelines.
• Ability to analyze and solve problems.
• Ability to seek out new methods and processes to improve services.
• Ability to utilize verbal and written communication skills effectively.
• Knowledge of the CPT® coding system and familiarity with ICD-10-CM and HCPCS Level II.
• Knowledge of Centers for CMS-HCC risk adjustment model and methodologies.