Risk Adjustment Coder (On-site)

Maintain Compliance

Maintains compliance with Gonzaba Medical Group policies, Official Coding Guidelines, and the Gonzaba Medical Group Coder’s Pledge.

Queries and Technical Guidance

• Provides queries or technical guidance to physicians, clinical staff, and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines.

Validation and Abstraction

• Accurately validate and abstract diagnosis codes from provider documentation in the patient medical record to ensure that reported ICD-10 codes are appropriately supported by the documentation.
• Selects correct ICD-10-CM (diagnostic), CPT (procedural) and HCPCS codes based upon interpretation of office visit and other documentation, correct coding principles, and clinical validation with a focus on accurate capture of all supported HCC diagnosis codes.

Review and Audit

• Remains up to date on all coding changes and usage.
• Performs review of Risk Adjustment audits for accuracy and for data entry into the EMR.
• Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ICD-10 coding; review of various payer denial/rejection reports to identify areas for provider education.

Electronic Forms Submission

• Completes required electronic forms necessary for submission of applicable acuity diagnosis codes based on scheduled appointments.