Certified Professional Coder Risk Adjustment

Valora Medical Group; Orlando (FL); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Valora Medical Group is seeking a Risk Adjustment (MRA) Coder/Auditor to ensure accurate identification of chronic conditions and ICD-10 coding to support correct billing. The role includes training providers, producing regular office reports, and improving documentation quality.

This is a hybrid position with onsite training support. Required: Bachelor’s in healthcare or related field, 2+ years coding plus 1+ year risk adjustment experience, and Certified Professional Coder; Certified Risk

Qualifications

• Bachelor’s degree in healthcare or related field required or preferred.
• 2+ years coding experience and 1+ years Risk Adjustment, CMS, HCC model experience.
• Certified Professional Coder is required.
• Certified Risk Adjustment Coder is highly preferred.
• Understanding of Medicare program, Medicare Advantage plans, and medical insurance industry.
• Strong written, verbal communication and interpersonal skills.
• Ability to handle confidential information with discretion.

Responsibilities

• Validate and abstract risk adjustment diagnosis codes using a coding platform and chart reviews.
• Review medical records and billing history to confirm correct billing and documentation.
• Send daily and weekly reports supporting each medical office.
• Implement process improvements to maximize risk adjustment factor accuracy.
• Follow CMS guidelines for risk adjustment and ensure accuracy of diagnosis information.
• Assist with HEDIS chart reviews and reporting of quality codes.
• Train and mentor providers and clinical staff on HCC coding/documentation and measures.
• Handle additional duties as assigned by management.

Skills

Communication

Customer Service

Flexibility

Confidentiality

Education

Bachelor’s Degree in healthcare or related field

Certified Professional Coder

Certified Risk Adjustment Coder

Job description

Location: Orlando, FL

Job Id:266

# of Openings:1

Valora Medical Group is a visionary company focused on high-quality primary care services and consisting of healthcare providers and professionals dedicated to the health and well-being of our patients. At Valora, we treat our patients like family.

With multiple locations throughout the Dallas-Fort Worth and Central Florida area, we understand that providing quality medical care and an exceptional patient experience across all our centers requires having an outstanding team.

A Risk Adjustment (MRA) Coder ensures all significant chronic conditions found in the patient’s chart affecting the risk score are identified to allow the Clinical Provider to determine which conditions are current so they can be addressed during the patient visit. This role is also responsible for proper identification of respective ICD-10 codes to ensure the accuracy of billing for addressed diagnoses. In addition, the MRA Coder/Auditor provides educational support regarding complete documentation.

This is a hybrid position, and will require onsite support when training Providers.

Essential Duties and Responsibilities:

• Validate and abstract risk adjustment specific diagnosis codes utilizing a computer assisted coding platform and chart/document reviews.
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• Responsible for sending daily and weekly reports supporting each medical office.
• Implement process improvements that will maximize risk adjustment factor accuracy and appropriate documentation.
• Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy, completeness, specificity and appropriateness of diagnosis information.
• Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality codes.
• Train and mentor medical providers and relevant clinical staff regarding appropriate HCC coding/documentation and HEDIS measures.
• Additional duties assigned by management

Abilities/Skills

• Communication: Communicates clearly and concisely; attentive listener.
• Customer Service: Establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Flexibility: Easily adapts to change.
• Confidentiality: Ability to always maintain patient’s discretion.

Qualifications/Education:

• Bachelor’s Degree in healthcare or related field is preferred
• 2+ Years coding experience and 1+ years of direct Risk Adjustment, CMS, HCC Model experience
• Certified Professional Coder is required
• Certified Risk Adjustment Coder is highly preferred
• Understanding of Federal Medicare program, Medicare Advantage Plans, and the medical insurance industry
• Must have effective written, verbal communication, and interpersonal skills
• Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette in dealing with others
• Ability to handle confidential information with discretion
• Strong analytical skills with attention to detail
• Ability to learn new procedures and adapt quickly to changeInnovative, motivated, organized, and team player
• Follow through with commitments.
• Ability to work independently
• Proactive and self-starter.

EEO Statement: Valora Medical Group, LLC is an equal opportunity employer and does not discriminate on the basis of race, color, religion, creed, sex, national origin, age, disability, pregnancy status, sexual orientation, gender identity, veteran status, marital status, genetic information, citizenship status, or other status protected by law. In compliance with the Immigration Reform and Control Act of 1986, we will hire only U.S. citizens and aliens lawfully authorized to work in the United States.