Retro-Coding - Coder

About the role

The Risk Adjustment Coder with AHIMA or AAPC certification performs medical record diagnosis code abstraction based upon clinical documentation, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinic Guidance, CMS program guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Risk Adjustment Coder will apply guidance provided for the medical record code abstraction primarily for Medicaid lines of business (Complete Code Capture), but may also include Medicare Advantage Risk Adjustment or Commercial Risk Adjustment.

Responsibilities

• Perform code abstraction of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
• Identify diagnosis and chart level impairments and documentation improvement opportunities for provider education
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
• Able to pass coding quiz with 80% accuracy
• Consistently maintain a minimum 95% accuracy on coding quality audits
• Meet minimum productivity requirements as outlined by the project terms
• Able to adhere to client guidelines when superseding other guidelines
• Assist coding leadership by making recommendations for process improvements to further enhance coding goals and outcomes
• Handle other related duties as required or assigned

Requirements

• Minimum of 3 years certified with a core coding credential from AHIMA or AAPC
• Must be one of the following (CRC, CPC, CCS, CCS-P)
• Experience and proficiency working with Medicaid plans
• 1+ years Strong organizational skills
• Technical savvy with high level of competence in basic computers, Microsoft Outlook, Word, and Excel
• Strong written and verbal communication skills
• Ability to work independently in a remote environment
• Minimum of 1 recent year of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months)
• Required code set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial benefit plans
• Minimum of 1 year coding experience with Complete Code Capture

Qualifications

• Minimum of 1 recent year of production coding experience in Retrospective Risk Adjustment coding (must be within last 6 months)
• Required code set knowledge and coding experience in Medicaid (primary), Medicare, and Commercial benefit plans
• Minimum of 1 year coding experience with Complete Code Capture

Skills

• Certified through AHIMA or AAPC required (CRC, CPC, CCS, CCS-P Certification Required)

Benefits

• Comprehensive medical, dental, vision, and prescription coverage
• Wellness program supporting overall well-being
• Company-paid basic life and AD&D insurance
• 401(k) plan with company match
• Tuition reimbursement opportunities
• Paid time off for vacation and illness
• Six paid company holidays
• Floating holiday
• Company-paid training and computer equipment
• Performance-based bonus program
• Paid time off for volunteer activities
• Employee referral bonus program
• Career development and training opportunities, including leadership growth

Pay

Compensation transparency factors which may affect starting pay within this range may include geography/market, skills, education, experience, and other qualifications of the successful candidate.

Schedule

Remote work environment