Risk Adjustment Coder Professional Billing II

Prisma Health; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health organization seeks a skilled candidate for HCC coding roles in Boyce Lawn, South Carolina. You will lead prospective and retrospective reviews to identify and confirm coding opportunities with providers. The role requires five years of professional coding experience along with CPC and CRC certifications. The ideal candidate will excel in communication and proficiency in healthcare coding software. Join us to inspire health and serve with compassion.

Qualifications

• Five (5) years professional fee coding experience.
• Certified Professional Coder (CPC) certification required.
• Certified Risk Adjustment Coder (CRC) certification required.

Responsibilities

• Conducts prospective review of charts to identify HCC opportunity.
• Conducts retrospective review of charts to confirm documentation supports reporting.
• Communicates with providers about HCC opportunities for improvement.

Skills

Knowledge of office equipment (fax/copier)

Proficient computer skills including word processing, spreadsheets, database

Data entry skills

Mathematical skills

Education

High School diploma or equivalent

Associate degree preferred

Tools

Payor specific software

Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Conducts prospective review to abstract Hierarchical Condition Categories (HCC's) codes to report for the calendar year. Communicates (via Epic and in person) with providers on any outstanding HCC capture opportunities. Conducts retrospective reviews to ensure that documentation supports reporting the Hierarchical Condition Category code prior to payor submission.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference.
• Conducts prospective review of charts to identify HCC opportunity.
• Conducts retrospective review of charts to confirm documentation supports reporting.
• Utilizes payor specific software to assist in capturing HCCs.
• Communicates with providers about HCC opportunities for improvement.
• Identifies suspect conditions that would potentially support reporting an HCC.
• Participates in education offerings.
• Participates in monthly meetings.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

Performs as a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

• Education: High School diploma or equivalent or post‑high school diploma / highest degree earned. Associate degree preferred.
• Experience: Five (5) years professional fee coding experience.

In Lieu Of

NA

Required Certifications, Registrations, Licenses

• Certified Professional Coder (CPC).
• Certified Risk Adjustment Coder (CRC).

Knowledge, Skills and Abilities

• Knowledge of office equipment (fax/copier).
• Proficient computer skills including word processing, spreadsheets, database.
• Data entry skills.
• Mathematical skills.

Work Shift

Day (United States of America)

Location

Independence Pointe

Facility

7002 Value-Based Care and Network Services

Department

70028459 HCC Coding Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.