Medical Risk Adjustment Coder- VBC

DaMar Staffing; Winter Park (FL); On-site; USD 60,000 - 80,000; Full time

Job summary

Orlando Health is seeking a Medical Risk Adjustment Coder to support physician practices and the Care Coordination Department. The role focuses on coding improvement activities, chart reviews, and ensuring accurate diagnosis capture for Medicare and related programs.

The position requires two years of Medicare Risk Adjustment experience, CPC/CRC certification, and strong written/verbal communication skills.

Qualifications

• High School Diploma or equivalent required.
• Experience in medical coding with Medicare Risk Adjustment preferred.
• Excellent written and verbal communication skills; ability to write concisely and effectively when communicating with diverse stakeholders.

Responsibilities

• Collaborates with internal and external clients to streamline and optimize accurate diagnosis code capture.
• Performs chart and billing audits to validate diagnoses for Medicare/Medicare Advantage and ACO programs.
• Reviews medical records and billing history to ensure accurate documentation and billing for risk adjustment.
• Ensures compliance with CMS guidelines and risk adjustment requirements across processes.
• Assists in the development and distribution of coding and documentation improvement materials.

Skills

Excellent written and verbal comms

Education

High School Diploma or equivalent

Tools

Windows

Microsoft Word

Microsoft PowerPoint

Microsoft Excel

Job description

Position Summary

About Orlando Health

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida's east to west coasts and beyond.

Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life. We begin your benefits on day one and offer flexibility wherever possible so that you can be present for your passions. "Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you.

Position Summary

The Medical Risk Adjustment Coder supports the physician practices and the Care Coordination Department with Coding Improvement activities using various clinical data systems.

Responsibilities

Essential Functions

• Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
• Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of
• Identifying and validating reported diagnoses for Medicare/Medicare Advantage and ACO health plan members.
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• 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 measures. .
• Demonstrates analytical and problem-solving ability in the process of reviewing submitted
• Diagnosis codes, comparing to actual services provided to the patient, and communicates appropriate feedback to providers and billing personnel.
• Performs analysis and focused chart reviews for targeted provider education training projects.
• Assists in the acquisition, development and distribution of coding and documentation improvement educational materials.
• Provides articles for the quarterly coding newsletter.
• Facilitates collection, validation, distribution and follow-through support of monthly and quarterly HCC coding reports for all providers participating in the Managed Medicare Program and Accountable Care Organization Programs.
• Places emphasis on compliance with Risk Adjustment procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
• Coordinates data collection and aggregation on a variety of focused audits and HCC coding capture projects.
• Validates the results of payer audits and translates findings into educational opportunities and tools to optimize revenue recovery.
• Offers support in the Care Coordination Department, focusing on provider and staff education.
• Facilitates ongoing quality metrics monitoring & assists with providing quarterly quality metrics reports for each PCP.
• Performs data validation and integrity functions in a variety of systems pertaining to patient care, clinical documentation, charge entry & billing, and payer claims management.
• Documents and reports activities regarding program status.
• Reviews, analyzes and modifies data as necessary to meet both internal and external customer needs
• Works with clinical staff to analyze reports and collaboratively identify improvement opportunities.
• Monitors quality, cost and efficiency on a recurring basis.
• Remains available when needed to attend Managed Medicare meetings, record minutes, and translate meeting outcomes into action plans that yield measurable results.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Maintains established work production standards.
• Assumes the responsibility for professional growth and development.
• Ability to work independently in a time-oriented environment.
• Participates in professional healthcare and community associations to keep abreast of current healthcare trends is expected.

Qualifications

Education/Training:

• High School Diploma or equivalent.

Licensure/Certification

• Must maintain current one of the following: * Certified Professional Coder (CPC) * Certified Risk Adjustment Coder (CRC)

Experience

• Prior HCC/HHS experience with Medicare Risk Adjustment with two (2) years' experience in medical coding.
• Computer literate with skills in Windows, Microsoft Word, Microsoft PowerPoint, Microsoft Excel.
• Excellent written and verbal communication skills; ability to write concisely and effectively when communicating…