Risk Adjustment Coder

About the Role

The Risk Adjustment Coder will identify, collect, assess, monitor, and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The role requires following procedures and documentation policies regarding claim/encounter information and providing appropriate support to justify recommendations.

Responsibilities

• Review medical record information to identify all appropriate coding based on CMS HCC categories.
• Prepare medical charts and track patient information via Excel spreadsheets.
• Complete appropriate paperwork, documentation, and system entry regarding claim/encounter information.
• Provide coding support, education, and training related to quality of documentation, level of service, and diagnosis coding consistent with established coding guidelines and standards.
• Provide real-time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS, and STARS.
• Monitor coding changes to ensure the most current information is available.
• Work HCC suspect reports.
• Accurately code and submit encounters on a timely basis.
• Research and address code questions for multiple provider offices as directed.
• Update the Director on status weekly.
• Notify Patient Experience Manager if annual wellness visits for patients have not been scheduled.
• Travel to offices as necessary to complete on-site chart reviews.
• Perform post-audits on assigned offices and notify office contact when codes are not addressed for provider review.
• Support and participate in process and quality improvement initiatives.
• Assist with billing claims as assigned.
• Maintain current knowledge of coding changes through affiliated classes and individual efforts.

Requirements

• Two (2) years prior medical coding experience.
• CPC, CPC-A, CCS-P, or CRC Coding Certification.
• Proficient in Microsoft Word and Excel.
• Strong organization and process management skills.
• Strong collaboration and relationship-building skills.
• High attention to detail.
• Excellent written and verbal communication skills.
• Ability to learn new tasks and concepts.

Skills

• Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one’s actions.
• Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.
• Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces changes, and constructively resolves barriers and constraints.
• Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places emphasis on the success of medical centers and insurance companies.

Physical Requirements

This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk, and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include the ability to lift up to 50 lbs. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Tools and equipment used include computers and peripherals, standard and customized software applications, and usual office equipment.