Risk Adjustment Coder

ExactCare Pharmacy; New Jersey; Remote; USD 60,000 - 75,000; Full time

Job summary

AnewHealth is seeking a Professional Remote Medical Coder to ensure compliance with coding regulations while optimizing reimbursement. This role requires expertise in ICD-10-CM coding and involves reviewing medical records. The ideal candidate will have strong communication skills and a detail-oriented approach, working remotely to support healthcare programs effectively.

Benefits

Medical/Dental/Vision Insurance

Flexible Spending

401(k)

Paid Time Off

Paid Holidays

Qualifications

• At least 6 months experience coding ICD-10 CM.
• Experience with MS Office applications.
• Strong written and verbal communication skills.

Responsibilities

• Review, analyze, and code diagnostic and procedural information.
• Perform medical record reviews and coding to comply with regulations.
• Interact with clients and co-workers to communicate information.

Skills

Communication

Detail Oriented

Education

Certified Coding Specialist (CCS)

Certified Professional Coder (CPC)

Certified Professional Coder Apprentice (CPC-A)

Certified Coding Associate (CCA)

Registered Health Information Administrator (RHIA)

Tools

MS Word

Excel

PowerPoint

Job description

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. We enable better outcomes for patients and the healthcare organizations who support them. Established in 2023 through the combination of ExactCare and Tabula Rasa HealthCare, we provide a suite of solutions that includes comprehensive pharmacy services; full-service pharmacy benefit management; and specialized support services for Program of All-Inclusive Care for the Elderly. With over 1,400 team members, we care for more than 100,000 people across all 50 states.

We are seeking a Professional Remote Medical Coder who will apply his or her technical and specialized expertise to help healthcare programs remain compliant with government regulations while identifying opportunities for increased financial success. The Professional Medical Coder will work from his or her home office to review, analyze, and code diagnostic and procedural information from medical records that determine payments to our clients. The primary function of this position is to perform ICD-10-CM, CPT and HCPCS coding for reimbursement. The coding function is a primary source for data and information used in health care today, and promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.

The Remote Medical Coder will:

Perform medical record reviews and use coding principles to code to the highest specificity and comply with CMS and HIPAA regulations as well as company goals and policies.

Perform Quantitative and Qualitative analysis of paper and electronic medical records for completeness, consistency and accuracy.

Perform risk adjustment data validations using AHA coding guidelines.

Interact with clients and co-workers to communicate value added information, make improvements and maintain strong partnerships.

Be a constant learner, performing research and staying abreast of updates to remain top in his/her field.

Requirements

The successful candidate for this position will:

Possess valid Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association, Certified Professional Coder (CPC) designation, Certified Professional Coder Apprentice (CPC-A) designation or CCA designation with at least one year of coding experience. Being a Registered Health Information Administrator (RHIA) is a plus.

Possess at least 6 months experience coding ICD-10 CM.

Have experience with MS Word, Excel, PowerPoint, and be comfortable learning and becoming an expert on new and proprietary software.

Have strong written and verbal communication skills, including propensity to establish and build strong relationships.

Take initiative to establish priorities, coordinate work activities and perform multiple and complex tasks while working independently and with minimal supervision in a remote setting.

Be detail oriented and quick to follow instructions and learn new tasks.

Possess a strong work ethic with impeccable integrity.*Documentation Improvement experience, experience in Hierarchical Condition Categories (HCC), knowledge of or experience in Medicare Advantage plans and knowledge of or experience in managed health care systems, PACE or Medicare are a plus.

AnewHealth offers a comprehensive benefit package for full-time employees that includesmedical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits,401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire .

AnewHealth provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.

About Us

AnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs—wherever they call home. The company enables better health and quality of life for patients while helping the healthcare organizations who support them improve key clinical and cost outcomes. Established in 2023 through the combination of ExactCare Pharmacy and Tabula Rasa HealthCare, AnewHealth provides a suite of solutions that includes comprehensive pharmacy services with national dispensing; proprietary science-based technology to optimize medication therapy; full-service pharmacy benefit management; and specialized support services for PACE (Program of All-Inclusive Care for the Elderly). Today, AnewHealth cares for more than 100,000 people nationwide through strong healthcare partnerships with risk-bearing providers, primary and specialty care providers, kidney care and dialysis providers, home health organizations, and managed care plans.

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Visit our website to learn about AnewHealth, our award-winning culture and benefits!

AnewHealthand its affiliated companies is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.