REMOTE Risk Adjustment Coder (6-month contract)

Sanford Barrows Group; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

A healthcare recruiting firm is seeking a Senior Executive Recruiter to ensure compliance with coding standards and improve quality of care through detailed medical record reviews. Applicants should possess strong medical coding knowledge and a coding certificate, along with experience in primary care settings. This full-time position demands excellent communication skills and the ability to work under pressure.

Qualifications

• Advanced understanding of medical terminology and disease processes.
• Minimum of 3-5 years' experience in risk adjusting coding.
• Two or more years’ experience in a primary care environment.

Responsibilities

• Ensure compliance with coding and documentation guidelines.
• Review medical records to verify diagnosis codes.
• Conduct medical chart reviews to identify improvement opportunities.

Skills

Medical terminology understanding

Use of electronic medical records systems

Work efficiently under pressure

Excellent communication skills

High degree of accuracy

Education

High School Diploma or GED

Coding Certificate

Certified Risk Coder (CRC) or equivalent experience

Tools

Microsoft Office Suite

Job description

Overview

Senior Executive Recruiter with the Sanford Barrows Group: The Risk Adjustment Coder works in a collaborative effort directly with physicians and their office staff and other support departments to review medical records and other clinical documentation to identify appropriate risk adjustment codes and quality gap closure opportunities. A major focus of the position is to collect and review documents to support the organization’s quality and risk adjustment initiatives, which results in improving quality of care.

ESSENTIAL JOB DUTIES/RESPONSIBILITIES

• Ensures compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment Reviews of medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify whether:
• The diagnosis codes are supported by the documentation and ensure with ICD-10-CM Guidelines for Coding and Reporting.
• The diagnosis codes for each chronic or major medical condition have been captured correctly.
• Any diagnosis code that is unsubstantiated by the record should be queried to provider and assess to accuracy.
• Reviews for clinical indicators and query providers to capture the severity of illness of the patient.
• Conducts medical charts to identifying opportunities for improving individual member risk adjustment score accuracy.
• Provides feedback to internal clients on:
• Examples of documentation and physician self-coding that do not meet quality standards.
• Examples of missed operations missed opportunities.
• Examples of clinical that ensure quality and timely care of our members as well as correct reimbursement.
• Identifies clinical coding and documentation trends and training needs to improve the quality of documentation to reflect our patients’ health data.
• Attends all meetings as required.
• Other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS & ABILITIES

• Advanced understanding of medical terminology, body systems/anatomy, physiology and concepts of disease processes.
• Demonstrated ability to utilize a variety of electronic medical records systems.
• Ability to manage significant work load, and to work efficiently under pressure meeting established deadlines with minimal supervision.
• Excellent written and oral communication for representation of clear and concise results.
• Must possess high degree of accuracy, efficiency and dependability.

EDUCATION AND EXPERIENCE CRITERIA

• High School Diploma or GED required.
• Coding Certificate required. APPC or AHIMA coding certified preferred.
• CRC (certified risk coder) is required, or minimum of 3-5 years’ experience in risk adjusting coding in lieu of certificate.
• Two (2) + years’ experience in a primary care environment is required.
• Strong knowledge of Microsoft Office Suite (Excel-basic mathematical formulas, charts, tables).
• Strong medical coding and third party operating procedures and practices.
• Knowledge of CPT/ICD-9 & 10 & Medical Terminology.

Seniority level

• Associate

Employment type

• Full-time

Job function

• Health Care Provider, Administrative, and Quality Assurance
• Industries

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