Certified Medical Coder - Risk Adjustment (HCC)

Porter Cares, Inc.; Pompano Beach (FL); On-site; USD 50,000 - 54,000; Full time

Benefits offered by this job

Competitive wage and benefits package

Opportunities for professional growth

Supportive, collaborative work enviro

Job summary

Porter Cares, Inc. is seeking a certified Risk Adjustment Coder with expertise in in-home assessments to ensure accurate CMS risk adjustment coding and high-quality documentation.

You will manage provider queries, work with multiple clients, and utilize coding clinics for education to enhance documentation practices. The role requires maintaining 98% coding accuracy, staying updated on CMS changes, and collaborating with clinical teams while adhering to HIPAA regulations.

Qualifications

• Minimum 5 years of experience in risk adjustment coding, including in-home assessments.
• Expertise in managing provider queries and driving documentation improvements.
• Proficient with coding clinics and reference tools for provider education.
• Strong CMS risk adjustment knowledge and HCCs.
• Experience with EMR and coding tools.

Responsibilities

• Assign ICD-10, CPT, and CPT II codes per documentation from in-home assessments.
• Manage provider query process for documentation accuracy.
• Handle multiple clients with varying coding requirements.
• Provide targeted feedback and education to providers.
• Maintain 98% coding accuracy.
• Stay current with coding standards and CMS changes.
• Collaborate with clinical teams to improve coding and documentation.
• Create and deliver training materials for providers.
• Maintain HIPAA confidentiality.

Skills

CMS risk adjustment

In-home assessments

Provider query management

Coding accuracy 98%

HIPAA compliance

EMR systems

Communication with providers

Education

CPC or CSS certification

Tools

EMR software

Job description

Position Overview

We are seeking a certified coder with expertise in risk adjustment coding and a specialization in in-home health assessments. The ideal candidate will have a strong understanding of CMS risk adjustment and quality initiatives, exceptional attention to coding quality, and experience managing the provider query process. This role also requires the ability to handle multiple clients, each with unique coding requirements, while ensuring accuracy and compliance. Proficiency in utilizing coding clinics for provider education and feedback is essential. This role will be instrumental in ensuring the accuracy of coding and improving the efficiency of our assessment workflows. A key expectation is that the Risk Adjustment Coder will maintain 98% coding accuracy.

Schedule: Monday - Friday (some weekends and overtime)

Start: 8am-8:30am ET

On-site: Pompano Beach, FL

*This is not a lead or manager position

Key Responsibilities

• Assign accurate ICD-10, CPT, and CPT II codes based on documentation from in-home assessments, ensuring compliance with CMS risk adjustment and quality guidelines.
• Manage the provider query process to clarify documentation and ensure the completeness and accuracy of patient diagnoses, particularly related to chronic conditions.
• Handle multiple clients with varying coding requirements, maintaining high standards of accuracy and adapting to specific client guidelines.
• Utilize coding clinics and other reference materials to provide providers with targeted feedback and education on improving documentation and coding accuracy.
• Maintain a minimum of 98% coding accuracy to meet performance expectations and ensure compliance.
• Stay current with coding standards, risk adjustment methodologies, and CMS regulatory changes to ensure ongoing compliance and optimal coding practices.
• Collaborate with clinical teams to review documentation and provide insights on areas for improvement in coding and documentation.
• Support coding education initiatives by creating and delivering training materials to providers, particularly focused on improving documentation practices.
• Maintain confidentiality and ensure full compliance with HIPAA regulations.

$50,000 - $54,000 a year

This is not a leadership or senior position.

Qualifications

• Certification Required - CPC or CSS
• Minimum 5 years of experience in risk adjustment coding, with specific experience in in-home assessments.
• Expertise in managing provider queries and improving provider documentation through coding feedback.
• Proficiency in using coding clinics and reference tools for accurate coding and provider education.
• Strong knowledge of CMS risk adjustment and quality initiatives, including Hierarchical Condition Categories (HCCs).
• Experience with electronic medical records (EMR) and coding tools.
• Excellent communication skills, with the ability to collaborate with providers and clinical teams to drive coding improvements.
• Strong attention to detail, prioritizing coding quality and compliance.

Preferred Qualifications

• Experience in coding audits and providing actionable feedback to providers.
• Knowledge of healthcare reimbursement models and regulations impacting risk adjustment coding.
• Prior experience in telehealth or in-home care settings.

Benefits

• Competitive wage and benefits package.
• Opportunities for professional growth and continuing education.
• A supportive, collaborative work environment.