Description

We are seeking a certified and experienced Risk Adjustment Coder to join our team. This role involves reviewing medical documentation for the accurate abstraction of conditions or diagnoses, treatments, and procedures in line with established coding standards.

The ideal candidate will have substantial experience in medical coding, with a keen eye for detail, impressive organizational skills, and a considerable understanding of the healthcare industry's intricacies.

Responsibilities:

1. Review and analyze patient records; ensure coding compliance with risk adjustment coding guidelines for diagnoses, treatments, and procedures.
2. Apply expert level knowledge of medical terminology, ICD-10-CM, and CPT coding principles in the completion of risk adjustment audits.
3. Carry out claim audits to identify incorrect coding and provide suitable solutions for correction.
4. Provide coding support to healthcare providers in the accurate compilation and submission of healthcare records.
5. Collaborate with the healthcare team to ensure the accuracy and completeness of clinical coding for risk adjustment purposes.
6. Maintain up-to-date knowledge of coding guidelines, utilizing resources effectively to ensure accuracy and compliance.
7. Detect fraud and abuse incidences by monitoring patterns and trends in risk adjustment data.
8. Conduct training and education for providers and staff on risk adjustment coding guidelines and compliance.
9. Assist with any additional coding or healthcare related tasks as needed.

Qualifications:

1. Must hold a CPC (Certified Professional Coder) certification.
2. Extensive experience in risk adjustment coding procedures and guidelines is essential.
3. Proficiency in medical terminology, ICD-10-CM, and CPT coding is required.
4. Strong knowledge of Medicare and/or Medicaid, health insurance practices, and healthcare regulatory requirements.
5. Excellent analytical, communication, and organizational skills.
6. Ability to handle confidential information with discretion.
7. Ability to work independently and in a team, prioritizing tasks to meet deadlines.
8. Proficient in computer literacy, including the use of coding software, Electronic Health Records (EHR) software, and Microsoft Office Suite.

Work Experience: Minimum of 3 years of experience in a risk adjustment coding role with a CPC certification.

Requirements

CPC Certified

Medical Terminology

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