MRA Coder

Genuine Health Group; United States; On-site; USD 70,000 - 90,000; Full time

Job summary

Genuine Health Group seeks a Medicare Risk Adjustment Coder to support retrospective and concurrent chart reviews, translating medical data into compliant HCC codes. You will collaborate with physicians, obtain records, and ensure accuracy in ICD-10 and CPT coding.

The role requires bilingual English/Spanish communication and strong Excel skills. You will drive compliance with federal and state guidelines, educate providers on documentation policies, and coordinate reviews with practices across

Qualifications

• Certification CPC/CPMA/CRC/CCS-P/CCS RHIA or RHIT required.
• Minimum 3 years of Medicare Risk Adjustment coding experience.
• Advanced Microsoft Excel skills.
• Familiar with HCC Dashboard tool.
• Proficient in ICD-10 and CPT coding.
• Fluent in English and Spanish.

Responsibilities

• Coordinate and support chart reviews to verify diagnoses are supported by documentation.
• Schedule chart reviews with physician practices.
• Obtain medical records to support audits requested by Health Plans.
• Ensure compliance with coding and documentation guidelines for Risk Adjustment.
• Educate physicians on proper billing and documentation policies.
• Identify and investigate spikes in low risk scores or incorrect coding; escalate appropriately.
• Perform additional duties as required.

Skills

HCC coding knowledge

English and Spanish fluency

ICD-10 and CPT coding

Education

CPC/CPMA/CRC/CCS-P/CCS RHIA or RHIT certification

Tools

Microsoft Excel

HCC Dashboard tool

Job description

Reports To: Medicare Risk Adjustment Director

Status: Full Time

Designation: 75% local travel

Responsibilities

The MRA Coder will be responsible for coordinating/supporting retrospective and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) coding to translate, input, extract and validate medical record data.

Job Duties

• Review patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries in order to verify whether the diagnosis codes are supported by the documentation to ensure they are within Guidelines for Coding and Reporting
• Schedule chart reviews with Physician practices
• Assist in obtaining medical records from Physicians to support audits requested by Health Plans
• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
• Educate Physicians regarding proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
• Demonstrate the ability to quickly identify low risk scores; incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and to forward problems to the attention of the Medicare Risk Adjustment Director
• Performs other duties as required.

Requirements

• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification
• Minimum 3 years of Medicare Risk Adjustment coding
• Advanced Microsoft Excel
• Familiar with HCC Dashboard tool
• Strong knowledge of ICD-10 and CPT codes
• Fluent in English and Spanish
• Clean driving record and reliable form of transportation