Risk Adjustment Coder

AnewHealth; United States; Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical/dental/vision

401(k)

Paid time off

Short-term disability

Life insurance

Job summary

AnewHealth is seeking a Professional Remote Medical Coder to apply expertise in ICD-10-CM, CPT and HCPCS coding for reimbursement while ensuring CMS/HIPAA compliance. Work from home, review medical records, and support programs across the country.

The ideal candidate has CCS/CPC/CCA designations and at least 6 months ICD-10 CM coding experience, with proficiency in MS Word, Excel, PowerPoint and strong communication skills.

Qualifications

• CCS/CPC/CCA designations with at least one year of coding experience; RHIA is a plus.
• At least 6 months of ICD-10-CM coding experience.
• Proficiency in MS Word, Excel, PowerPoint and learning new software.
• Strong communication, independent remote work capability, and attention to detail.

Responsibilities

• Perform medical record reviews and code to the highest specificity per CMS/HIPAA.
• Conduct quantitative and qualitative analysis of records for completeness and accuracy.
• Carry out risk adjustment data validations using AHA guidelines.
• Interact with clients and team to share value-added information and improve processes.
• Continuously learn and stay updated on coding guidelines and regulations.

Skills

Strong communication

Independent work

Detail oriented

Initiative

Documentation improvement

Education

CCS/CPC/CCA designations

RHIA (plus)

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.

Job Details

We are seeking aProfessional Remote Medical Coderwho 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.

Responsibilities

• 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.

The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not all of the duties may be assigned to a position.

Qualifications:

These represent the desired qualifications of the ideal candidate. They are not meant to limit consideration for candidates who do not meet all of the standards listed. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education

• 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.

Experience

• 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.

Skills & Abilities

• 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.

Physicals/Mental Demands:

This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed.

Schedule:

This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

This is a remote position.

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.