Risk Adjustment Coder

About the Role

The Risk Adjustment Coder will be responsible for coordinating/supporting Prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. This role serves as an important part of the care team to improve documentation and coding accuracy, and assist the primary care team in delivering high-quality preventive care to patients.

Responsibilities

• Review all available patient medical records, including medical history, physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries, and other relevant documents.
• Determine whether diagnosis codes are supported by documentation and comply with coding and reporting guidelines (M.E.A.T).
• Implement pre-visit and post-visit audit processes with assigned providers to accurately capture documentation and coding with the greatest level of specificity.
• Engage physicians and office staff to build and maintain positive working relationships, ensuring frequent touchpoints and scheduled meetings to discuss chart reviews.
• Assist in obtaining medical records from internal and external providers to ensure accurate documentation and support audits requested by Health Plans.
• Ensure compliance with Federal, State, and County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
• Educate physicians and office staff on proper billing, documentation policies, procedures, and address conflicting/ambiguous documentation.
• Identify missing documentation, coding opportunities, incorrect coding, and compliance trends; analyze and resolve suspected problems, escalating issues to management when necessary.
• Visit providers onsite to provide education and feedback based on chart reviews.
• Meet daily production and quality goals, maintaining a consistent 95% accuracy rate.
• Suggest and educate providers on correct coding (CPT/HCPCS Level II/ICD-10-CM/Modifiers) and ensure knowledge of HEDIS codes and NCQA guidelines.
• Perform other duties as assigned.

Qualifications

• High School or Associate’s Degree (Required)
• Clinical education (RN, LVN, LPN, Foreign Medical Graduate, Pharmacist) preferred

Requirements

• ICD-10 coding: 3+ years (Required)
• Medicare risk adjustment coding: 3+ years (Required)
• Prospective and concurrent Risk adjustment retrospective review: 2+ years (Required)
• Provider education: 1+ year (Required)
• CPT and E&M coding: 1+ year (Required)
• Outpatient Primary Care coding: 1+ year (Required)
• Elation EMR (Preferred)
• CPC / CPMA / CRC / CCS-P / CCS / RHIA or RHIT certification (Required)
• Bilingual Spanish preferred

Skills

• Strong knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding
• Ability to analyze and interpret medical records and documentation
• Excellent communication and interpersonal skills for provider education and collaboration
• Attention to detail and ability to maintain high accuracy rates
• Proficiency in outpatient primary care coding and medical record reviews

Benefits

• Purpose-driven career
• Competitive pay
• Best-in-class medical/dental coverage
• Free mental health and life coaching for team members and their dependents
• Holiday time off with pay
• Paid community service day
• Paid parental/family leave
• Paid bereavement leave
• Generous paid time off (PTO)
• 401k retirement plan with company match