HCC/Risk Adjustment Medical Coder

SKILLS & COMPETENCIES

• Fosters a culture of best demonstrated practices, customer and peer service-orientation, measurement, performance, accountability and continuous improvement
• Performs medical chart audits on both retroactive and prospective basis to identify, monitor and document claims and encounter coding information as it relates to Hierarchical Condition Categories (HCC)
• Performs coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes, and are adhering to CMS Risk Adjustment guidelines
• Educates clinicians on specific coding issues found in their charts, and regarding billing and documentation policies and procedures
• Review billing submissions
• Ensures reimbursement is maximized through appropriate coding via implementation of best practices and processes
• Manages annual recoding efforts
• Produces reports showing coding trends, clinician, community, PCP, etc.
• Performs mock RADV audits
• Engages health plans/government agencies
• Reviews and owns all training
• Complies with all aspects of Coding and adheres to official coding guidelines
• Performs auditing analysis and provides feedback on noncompliance issues detected through auditing process
• Stays up-to-date on industry coding and compliance issues
• Is a Leader
• Other tasks needed to accomplish team’s objectives/goals

Educational/ Experience Requirements:

• 2 years’ post-high school education or a degree from a two-year college

Licensure, Certification, or Regulatory Requirements:

• Coding certification through AAPC or AHIMA required- Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPC

Required Skills and Abilities:

• Minimum of two (2) years’ experience of ICD-9/10, CPT, HCPCS coding experience
• Experience in healthcare reimbursement or revenue cycle or several years of overall health care experience
• Knowledge of Risk Adjustment and Hierarchical Condition Categories (HCC) and Medicare Advantage reimbursement a plus
• Knowledge of CMS coding guidelines
• Knowledge of Medical Terminology, disease process and anatomy and physiology
• Computer literate with medical billing software
• Proficient in Word, Excel, Microsoft Access
• Innovates new programs
• Execution and result oriented
• Ethics and integrity
• Teamwork
• Attention to detail
• Professional demeanor

Supervisory Responsibility: This position will have supervisory responsibility.

Travel requirements: This position will not have 0% travel required.

Work Conditions: Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. Ability to stand for extended periods.

Ability to drive to patient locations (ie. home, hospital, SNF, etc). Fine motor skills/Visual acuity .

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role

The Coding Specialist is responsible for performing medical chart audits for ICD-10-CM coding and documentation. Interfaces with clinicians and management on chart audit findings and delivers education to clinicians as needed.