Risk Adjustment Coder

Revere Medical; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization is seeking an outpatient risk coder to work remotely in collaboration with providers and practice staff. The successful candidate will review medical records, ensure accurate diagnosis coding, and participate in performance improvement initiatives while maintaining confidentiality. Applicants should possess an associate degree in healthcare, be certified as a Professional Coder (CPC) and Risk Coder (CRC), and have 2-3 years of relevant experience. Strong organizational and communication skills are essential.

Qualifications

• 2-3 years of experience in outpatient coding preferred.
• Familiarity with CMS-HCC and HHS-HCC Risk Adjustment coding.
• Advanced knowledge of CPT and ICD-10 coding required.

Responsibilities

• Review outpatient medical record information for coding.
• Ensure timely submission of diagnosis codes.
• Audit provider documentation for accuracy.

Skills

Strong organizational skills

Communication skills

Interpersonal skills

Attention to detail

Ability to work independently

Education

Associate degree in healthcare

Certified Professional Coder (CPC)

Certified Risk Coder (CRC)

Tools

Electronic medical records

MS Office (Outlook, Excel, Word)

Job description

Position Purpose: This position reports to the Manager of Risk Adjustment Coding for Revere Medical Group in Westwood, MA. As a member of the Risk Adjustment team, the Outpatient Risk Coder works remotely in collaboration with Providers and Practice Staff with opportunities for improved risk adjustment coding performance and medical record documentation. The Outpatient Risk Coder is a valuable resource in process improvement and identifying clinically appropriate risk adjusting conditions to capture. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications.

Responsibilities

• Review outpatient medical record information on both a prospective, concurrent, and retrospective basis to identify, assess, monitor and document claims and encounter coding information as it pertains to risk adjustment and quality metrics
• Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe
• Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
• Audit provider documentation ICD-10 codes to ensure adherence with CMS Risk Adjustment guidelines
• Participate in departmental and physician network performance improvement initiatives.
• Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security.
• Performs other duties as requested.

Education / Experience / Other Requirements

• Associate degree in healthcare or equivalent work experience.
• Certified Professional Coder (CPC) and Certified Risk Coder (CRC).

Years Of Experience

• 2-3 years of experience in outpatient coding preferred.

Specialized Knowledge

• Familiarity and understanding of CMS-HCC and HHS-HCC Risk Adjustment coding and data validation requirements.
• Computer literacy of medical information system, use of electronic medical records
• Advanced knowledge of CPT and ICD-10 coding required.
• Proficiency in MS office (outlook, excel, word).
• Knowledge of federal and state guidelines on all coding systems and sponsored programs
• Professional interpersonal and organizational skills.
• Attentive to detail and organization with ability to work with strict deadlines.
• Strong interpersonal and communication skills: able to effectuate areas of opportunity to providers and practices as well as leadership.
• Strong sense of diplomacy and ability to work under pressure.

Revere Medical does not discriminate in employment opportunities or practices on the basis of race, color, religion, gender, national origin, age, physical or mental disability, pregnancy, childbirth or related medical conditions, military service obligations, citizenship, sexual orientation, genetic information, or any other characteristic protected by applicable local, state, or federal law.