Risk Adjustment Coder II

About the role

Community Health Choice, Inc. (Community) is a non-profit managed care organization licensed by the Texas Department of Insurance. Community serves over 400,000 members through its network of providers and hospitals, offering various programs including Medicaid, CHIP, Health Insurance Marketplace Plans, and Medicare Advantage plans.

Responsibilities

• Provide advanced complex medical records reviews to identify and code all relevant diagnoses, including chronic conditions, using ICD-10 coding guidelines for Commercial and Medicare risk adjustment programs.
• Conduct thorough clinical documentation review to ensure sufficient support and management for coded conditions.
• Identify opportunities to improve documentation and coding accuracy; provide analysis and recommendations for improvement to leadership.
• Meet productivity and quality standards as outlined by supervisor.
• Ensure coding compliance by following Official Coding Guidelines, HHS-RADV Protocols, and attending REGTAP calls.
• Stay current with coding standards, risk adjustment methodologies, and CMS Regulatory changes to ensure ongoing compliance and optimal coding practices.
• Actively contribute to achieving departmental goals, including specific process improvement plans, and other duties as assigned.

Qualifications

• Bachelor's Degree or 5+ years of experience in risk adjustment in lieu of degree in managed care organization required.
• AHIMA/AAPC Certified Coder, Medical Billing and Coding certification required (CPC, CRC, COC, CCS, CCS-P, or any combination of listed certifications).
• Associate or bachelor's degree preferred.
• 3-5 years' experience in Commercial or Medicare risk adjustment coding required.
• Clinical Documentation Improvement Experience for Inpatient and Outpatient preferred.
• Experience within a managed care organization preferred.
• Solid knowledge of ACA, Medicaid, and Medicare Risk Adjustment.