Risk Adjustment Medical Coder / DRG CPT Validator

UST; Taguig; On-site; PHP 240,000 - 420,000; Full time

Job summary

UST is seeking a medical coder to map ICD-10-CM codes for risk adjustment models and to ensure accurate documentation and compliance with HIPAA. The role requires CPT proficiency, familiarity with risk adjustment processes, and onsite work on the graveyard shift in the Philippines.

The ideal candidate has at least 6 months of coding experience, a relevant certification (AAPC/AHIMA), and a strong understanding of chronic illness management.

Qualifications

• At least 6 months of medical coding experience.
• HCC Risk Adjustment Experience.
• Experience with In Patient, Out Patient, or Facility Coding.
• Well versed in CPT coding including modifiers.
• College graduate with at least 6 months of BPO experience.
• Active coding certification under AAPC or AHIMA.
• Certified Risk Adjustment Coding Certification (CRC) preferred.
• Able to code using ICD 10 CM physical codebook or coding software.
• Strong clinical knowledge related to chronic illness diagnosis, treatment, and management.
• Computer proficiency (MS Office and Internet).
• Must be able to work onsite on graveyard shift.

Responsibilities

• Assign appropriate ICD 10 CM codes mapping to risk adjustment models for Medicare Advantage and ACA Commercial Projects.
• Assign Flag events and CDI for documentation discrepancies.
• Comply with the Standards of Ethical Coding as set forth by the AHIMA and adhere to official coding guidelines.
• Comply with HIPAA laws and regulations.
• Maintain quality 97 percent and production standards.
• Remain current on diagnosis and coding guidelines and risk adjustment reimbursement reporting requirements.

Skills

Medical coding

HCC risk adjustment

ICD-10-CM

HIPAA

Education

College graduate

Job description

Role Description

Responsibilities include but are not limited to the following:

• Assign appropriate ICD 10 CM codes mapping to risk adjustment models for Medicare Advantage and ACA Commercial Projects.
• Assign Flag events and CDI for documentation discrepancies.
• Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines.
• Comply with HIPAA laws and regulations.
• Maintain quality 97 percent and production standards.
• Remain current on diagnosis and coding guidelines and risk adjustment reimbursement reporting requirements.

Qualifications

• With at least 6 months medical coding experience.
• HCC Risk Adjustment Experience.
• Experience with In Patient, Out Patient, or Facility Coding.
• Well versed in CPT coding including modifiers.
• Must be College Graduate with at least 6 months of BPO experience.
• Active coding certification under AAPC or AHIMA.
• Certified Risk Adjustment Coding Certification (CRC) preferred.
• Able to code using ICD 10 CM physical codebook or coding software.
• Strong clinical knowledge related to chronic illness diagnosis, treatment, and management.
• Computer proficiency (MS Office and Internet).
• Must be able to work onsite on graveyard shift.

Skills

ICD-10-CM, HIPAA, Medical Coding, Risk Adjustment Coding