Risk Adjustment Coder

Suvida Healthcare; Dallas (TX); In loco; USD 60.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

Competitive pay

Mental health coaching

Paid time off

Community service day

Parental leave

401k with match

Descrizione del lavoro

Suvida Healthcare seeks a Risk Adjustment Coder to support audit and coding in a primary care setting serving Medicare-eligible Hispanic seniors. You will review records, ensure documentation accuracy, and educate providers on CPT/HCPCS/ICD-10 coding within HEDIS and NCQA guidelines.

Onsite visits to practices are required; we value collaboration, accuracy, and timely production while helping our team deliver high-quality preventive care and health equity for our community.

Competenze

• ICD-10 coding: 3+ years (Required)
• Medicare risk adjustment coding: 3+ years (Required)
• Prospective and concurrent Risk adjustment retrospective review: 2+ years (Required)
• Provider education – 1+ year experience (Required)
• CPT and E&M coding: 1+ year (Required)
• Outpatient Primary Care coding: 1+ year experience (Required)
• Elation EMR (Preferred)
• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification (Required)

Mansioni

• Review all available patient medical records and ensure codes align with documentation and guidelines.
• Implement a pre-visit and post-visit audit process with providers.
• Engage physicians and office staff to maintain collaboration.
• Schedule meetings with providers to discuss chart reviews.
• Obtain medical records to support audits requested by Health Plans.
• Ensure compliance with Federal, State, and local coding regulations.
• Educate staff on proper billing and documentation policies.
• Identify missing documentation and coding opportunities; escalate issues as needed.
• Visit providers onsite for education and feedback based on chart reviews.
• Meet daily production and quality goals (95% accuracy).
• Suggest and educate on CPT/HCPCS/ICD-10 coding and modifiers.
• Knowledge of HEDIS and NCQA guidelines.

Conoscenze

ICD-10 coding

HCC coding

Medicare risk adjustment

Medical record reviews

Healthcare compliance

Formazione

CPC/CPMA certification

RHIA or RHIT certification

ICD-10 coding certification

Strumenti

Elation EMR

Descrizione del lavoro

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered, and more compassionate healthcare family and Employer of Choice! Will you join us Suvidanos , to help achieve our Higher Purpose?

What Makes Us Unique

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve.

How We Work

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward
• Competitive Pay
• Free Mental Health & Life Coaching for Team Members and their Dependents
• Holiday Time Off with Pay
• Paid Community Service Day
• Paid Parental/Family Leave
• Generous Paid Time Off (PTO)
• 401k Retirement Plan with Company Match
• And much more....

What You’ll Do

Position Summary

The Risk Adjustment Coder will be responsible for coordinating/supporting Prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. The Risk Adjustment Coder will serve as an important part of the care team to improve documentation and coding accuracy, and assist the primary care team to deliver high quality preventive care to patients.

Responsibilities

• Review all available patient medical records: Medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries and any other available medical records. Determine whether the diagnosis codes are supported by the documentation and are within the guidelines for coding and reporting (M.E.A.T).
• Implement a pre-visit and post visit audit process with assigned provider that accurately captures all documentation and coding with the greatest level of specificity.
• Engage physicians and office staff to build and maintain a good working relationship.
• Ensure frequent touchpoints with your assigned providers and schedule meetings to discuss chart review.
• Assist in obtaining medical records from internal and external providers to ensure accurate documentation and 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 and supporting office staff on proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Demonstrate the ability to quickly identify missing documentation and coding opportunities; incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and to forward problems to the attention of your manager.
• Must visit Providers onsite at their Practice to provider education and feedback based on chart reviews.
• Coder is responsible for meeting daily production goal and quality goal of averaging 95% accuracy rate on a consistent basis.
• Must have skill set for outpatient primary care coding and medical record reviews.
• Suggest and educate providers on correct coding CPT/HCPCS Level II/ICD 10 CM/Modifiers
• Must have knowledge on HEDIS Codes and NCQA guidelines.
• Other duties as assigned.

What You’ll Bring

Knowledge, Skills, and Abilities

• High School or Associate’s Degree Required
• Clinical education (RN, LVN, LPN, Foreign Medical Graduate, Pharmacist) preferred

Education, Experience, Licensure, or Certification Requirements

• ICD-10 coding: 3 + years (Required)
• Medicare risk adjustment coding: 3 + years (Required)
• Prospective and concurrent Risk adjustment retrospective review: 2 + years (Required)
• Provider education – 1 + year experience (Required)
• CPT and E&M coding: 1 + year (Required)
• Outpatient Primary Care coding : 1+ year experience (Required)
• Elation EMR (Preferred)
• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification (Required)

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any typewithregard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.