Risk Adjustment Coder

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Job Summary

The Risk Adjustment coder will identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories. Verify and ensure the accuracy, completeness, specificity, and appropriateness of diagnosis codes based on services rendered. The Risk Adjustment Coder is required to follow procedures and documentation policies regarding claim/encounter information and provide appropriate support to justify their recommendations.

Duties & Responsibilities

Essential Duties & Responsibilities

• Review medical record information to identify all appropriate coding based on CMS HCC categories

• Prepare the medical charts and track patient information via Excel spreadsheets.

• Complete appropriate paperwork/documentation/system entry regarding claim/encounter information

• Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards

• Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS

• Monitor coding changes to ensure that most current information is available

• Work HCC suspect reports

• Accurately code and submit encounters on a timely basis

• Researching and addressing code questions for multiple provider offices as directed

• Update the Director on the status on a weekly basis

• Notifies Patient Experience Manager if annual wellness visits for patients have not been scheduled.

• Travel to offices as necessary to complete on-site chart reviews

• Performs post-audits on assigned offices and notifies office contact when codes are not addressed for provider review.

• Support and participate in process and quality improvement initiatives.

• Assists with billing claims as assigned.

Additional Duties & Responsibilities

• Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. Due to the nature of this position, it is understood that coding requirements are expected to change; therefore, participation in affiliated classes and individual efforts to maintain current knowledge of these changes is required.

Education & Experience

• Two (2) years prior medical coding experience

• Proficient in Microsoft Word and Excel

• Strong organization and process management skills

• Strong collaboration and relationship building skills

• High attention to detail

• Excellent written and verbal communication skills

• Ability to learn new tasks and concepts

• CPC, CPC-A or CCS-P, CRC Coding Certification

Knowledge, Skills & Proficiencies

• Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments and takes responsibility for the impact of one’s actions.

• Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to the managed care plan.

• Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces changes and constructively resolves barriers and constraints.

• Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that places emphasis on the success of the medical centers and insurance companies.

Job Requirements

Physical Requirements

This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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