Certified Coder (Risk Adjustment Experience Required) - REMOTE

Job Summary

About the role

Provides support for medical coding activities, including ensuring that ICD-10 and CPT codes are reported accurately to maintain compliance, and minimize risk and denials. Contributes to overarching strategy to provide quality and cost-effective member care.

Responsibilities

• Performs on-going member medical chart reviews.
• Abstracts and reports ICD-10 and CPT diagnosis codes accurately and in compliance with established coding and billing principles - minimizing risk and denials.
• Demonstrates understanding of current provider office billing practices - ensuring that diagnosis and CPT codes are submitted accurately.
• Documents results/findings from chart reviews and provides feedback to leadership, providers and office staff.
• Provides training and education to provider network regarding risk adjustment and coding updates related to risk adjustment.
• Builds positive relationships between providers and the business by providing coding assistance as needed.
• Facilitates administrative duties such as planning, chart reviews scheduling, medical records procurement, provider training and education.
• Aids in coordination of management activities with other departments including finance, revenue analytics, claims, encounters and enterprise/plan medical directors.

Requirements

• At least 2 years medical coding experience, or equivalent combination of relevant education and experience.
• Certified Professional Coder (CPC).
• Certified Coding Specialist (CCS).
• Latest Centers for Medicare and Medicaid Services (CMS) and American Hospital Association (AHA) clinic coding knowledge.
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to effectively interface with staff, clinicians, and management.
• Excellent verbal and written communication skills.
• Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and all other customers.
• Strong verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency.

Qualifications

• Preferred qualifications include:
• Certified Risk Adjustment Coder (CRC).
• Certified Professional Payer – Payer (CPC-P).
• Certified Coding Specialist – Physician Based (CCS-P).
• Familiarity with HCC (Hierarchical Condition Categories) Risk Adjustment Model.
• Experience with risk adjustment data validation.

Skills

• Knowledge of ICD-10 and CPT coding standards.
• Proficiency in medical terminology and coding guidelines.
• Strong analytical and problem-solving skills.
• Effective communication and interpersonal skills.
• Ability to manage multiple tasks and prioritize responsibilities.

Benefits

Details of benefits will be provided upon employment.

Pay

$19.84 - $38.69 / HOURLY

Schedule

Details of schedule will be provided upon employment.