Certified Risk Adjustment Coder - Remote

Cypress Healthcare Partners; California; Remote; USD 65,000 - 90,000; Full time

Job summary

DaMar Staffing is seeking a Certified Risk Adjustment Coder to accurately abstract ICD-10 codes from medical documentation and ensure CMS guideline compliance across coding, documentation, and billing. You will perform concurrent, prospective, and retrospective reviews, educate providers, and deliver feedback to physicians to close risk adjustment gaps and improve overall quality.

Candidates should hold CPC and CRC certifications, possess Epic experience, and have at least three years in risk

Qualifications

• Education or equivalent: BS/BA in Health Science preferred; a two-year degree is acceptable.
• Certification CPC and CRC is required; additional CDI/auditing credentials are a plus.
• Minimum three years of experience in risk adjustment coding with provider education.

Responsibilities

• Perform coding quality audits to ensure ICD-10 codes align with documentation.
• Review provider documentation to identify gaps and deliver education sessions.
• Provide feedback to physicians on coding guidelines and documentation accuracy.
• Assist with in-services on compliant billing and regulatory requirements.
• Ensure compliance with federal coding and billing laws and CMS guidelines.
• Conduct pre-appointment chart reviews and coding-related projects.
• Provide real-time coding consultation to improve practices.
• Query providers for clarification on documentation queries.
• Serve as a resource for medical documentation questions.
• Maintain knowledge of current coding guidelines and annual updates.
• Review and update coding policies/procedures as needed.
• Perform other duties as assigned by supervisor.

Skills

Communication

Interpersonal skills

Organizational skills

Critical thinking

Team collaboration

Education

BS/BA in Health Science

Two-year degree required

Certified Professional Coder (CPC)

Certified Risk Adjustment Coder (CRC)

CDI/auditing certifications (CDDS, CDEO, CPMA) preferred

Tools

Epic

Job description

Job DescriptionJob Description

SUMMARY

The Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation.This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines.The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients.Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements.

ESSENTIAL JOB FUNCTIONS

• Perform coding quality audits of medical records to ensure ICD-10 codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS guidelines.
• Review provider documentation to identify clinical documentation gaps, and design, plan, and deliver education sessions to providers either individually or in group settings.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education on documentation supporting the most appropriate level of ICD-10 specificity.
• Assist with educational in-services for physicians, other providers, and clinic staff regarding accurate clinical documentation, best coding practice, and regulatory compliance related to billing.
• Ensure compliance with all applicable federal laws and regulations related to coding and documentation guidelines for healthcare billing.
• Perform pre-appointment chart reviews, coding audits, or other coding-related projects
• Provide real time coding consultation / review and evaluate documentation to improve coding practices
• Query providers for clarification on documentation inquiries
• Serve as a resource for providers regarding medical documentation inquiries
• Maintain knowledge of current coding guidelines, annual updates, and changes to ensure coding and billing compliance.
• Review and update coding policies and procedures as needed
• Perform other job duties as required by manager / supervisor

SUPERVISORY RESPONSIBILITIES

None

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and / or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Excellent communication, interpersonal, and organizational skillsExperience with Epic is requiredStrong critical thinking abilitiesAbility to adapt quickly to changes in policy, practice, and proceduresEnergetic and proactive, with the ability to work both independently and as part of a team

EDUCATION / EXPERIENCE and SKILLS

Education :BS / BA Degree in Health Science or General Education is highly preferred; however, completion of a two-year degree is required.Certifications :Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC), or equivalent coding certifications are required.Additional certifications in Clinical Documentation Improvement (CDI) or auditing (e.g., CCDS, CDEO, CPMA) are preferred.Experience :3years of experience in risk adjustment coding.Experience in provider education, clinical documentation improvement (CDI), and chart audits.

CONDITION OF EMPLOYMENT

Cypress Healthcare Partners requires you to prove that you have received the COVID-19 vaccine or have a valid religious or medical reason not to be vaccinated.The range displayed on this job posting reflects the target for new hire salaries for this position..