Risk Adjustment Coder

Suvida Healthcare; Dallas (TX); On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Competitive pay

Medical/dental coverage

Mental health coaching

Paid time off

401k with match

Job summary

Suvida Healthcare seeks a Risk Adjustment Coder to support chart reviews and coding for Medicare-eligible Hispanic seniors. You will translate and validate data using HCC guidelines, coordinate with providers, and improve documentation and coding accuracy within the care team.

You will visit providers onsite, educate staff on coding policies, and meet daily production and 95% accuracy goals. Requires ICD-10 and Medicare risk adjustment experience, CPC/CPMA or RHIA/RHIT certification preferred.

Qualifications

• ICD-10 coding with 3+ years of experience required.
• Medicare risk adjustment coding experience required.
• Prospective and concurrent risk adjustment review experience.
• Provider education experience required.

Responsibilities

• Review patient records to verify diagnosis codes align with guidelines.
• Audit documentation pre- and post-visit with providers.
• Educate physicians and staff on proper billing and documentation.
• Ensure compliance with coding guidelines for risk adjustment, including HEDIS/NCQA.

Skills

HCC risk adjustment

Education

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

RN / LVN / LPN or foreign medical graduate

Tools

Elation EMR

Job description

Risk Adjustment Coder

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.

We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve.

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward

Our Promise

• Purpose Driven Career
• Competitive Pay
• Best-In-Class Medical/Dental Coverage
• Free Mental Health & Life Coaching for Team Members and their Dependents
• Holiday Time Off with Pay
• Paid Community Service Day
• Paid Parental/Family Leave
• Paid Bereavement Leave
• Generous Paid Time Off (PTO)
• 401k Retirement Plan with Company Match
• And much more...

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 provide 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)
• Bilingual Spanish preferred

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard 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.