Certified Risk Adjustment Coder

CMP01 Mount Sinai Medical Center of Florida, Inc.; Town of Florida (NY); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health benefits

Life insurance

Long-term disability coverage

Healthcare spending accounts

Retirement plan

Paid time off

Tuition reimbursement

Employee assistance program

Wellness program

On-site housing for select positions

Job summary

Mount Sinai Medical Center seeks an experienced Medical Coder with CPC/CCS-P/CRC certification and 5+ years of coding and billing experience to support risk adjustment work. You will review records for accurate ICD-10-CM and CPT coding and collaborate with physicians to improve documentation.

Proficiency with Epic and a strong understanding of CMS risk adjustment models are essential. The role emphasizes accuracy, timely chart reviews, and ongoing credential maintenance within a collaborative

Qualifications

• Certification CPC, CCS-P or CRC required.
• Education: High School graduate.
• Five+ years of coding and billing experience.
• Knowledge of ICD-10-CM and CPT.

Responsibilities

• Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment guidelines and HCCs.
• Reviews medical records to ensure all diagnosis codes are documented for valid HCC assignment.
• Regularly reviews Epic HCC and payor CSI reports.
• Queries and educates physicians on documentation deficiencies to improve risk adjustment coding accuracy.
• Understands risk adjustment payment models and financial impact of queries.
• Uses clinical reasoning to prioritize coding efforts efficiently.
• Completes patient chart review within 24-48 hours of visit.
• Maintains active status of coding credentials and completes annual CE hours.
• Maintains professional relationships with physicians, managed care, and other departments.
• Performs other related duties.

Skills

ICD-10-CM knowledge

CPT knowledge

Medical coding experience

Epic HCC review

Education

High School diploma

Tools

Epic

Job description

As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers. Culture of Caring: The Sinai Way Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida.

We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Department:

Job Description Summary:

Position Responsibilities

• Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment guidelines and HCCs (hierarchical condition categories)
• Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care
• Regularly reviews Epic HCC and payor CSI (Clinically Suspect Conditions) reports
• Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding
• Demonstrates understanding of risk adjustment payment models
• Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently
• Completes patient medical chart review within 24-48 hours of visit completion
• Responsible for maintaining active status of coding credentials and completes annual continued education hours
• Observes work hours and provides proper notice regarding absences and tardiness
• Maintains positive working relationship with Physician Practices, Managed Care and all other departments and communicates with office staff as needed
• Performs other related duties

Qualifications

• License/Registration/Certification CPC, CCS-P or CRC Certification Required
• Education High School graduate
• Experience Five plus years experience in Coding and Billing
• Knowledge of ICD-10-CM and CPT

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!

Degree Requirements:

Certification: More than 4,000 people work at Mount Sinai Medical Center at more than a dozen locations throughout sunny South Florida, including our flagship, 672-bed hospital on Biscayne Bay at the gateway to Miami Beach. We’re the largest, independent, not-for-profit hospital in South Florida, and we’re the only hospital Healthgrades recognized for four years running as one of the top 5% in the nation. Clearly, clinical excellence is at our core.