Medical Coder Ii - Risk Adjustment Coder

SUMMARY:  

The Risk Adjustment Coder is responsible for the management of the Hierarchical Condition Category (HCC) and Risk Adjustment Coding, for the ACO REACH Program, providing oversight of concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture and complexity of the patient’s condition(s).  The Risk Adjustment Coder utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), HCCs and Risk Adjustment Factor (RAF) scoring.  Includes, but is not limited to, reviewing the Risk Adjustment provider clinical documentation and partnering with provider/clinical staff to resolve issues. 

The position is full-time, Monday through Friday.

DUTIES AND RESPONSIBILITIES:

 Primary Responsibilities

• Reviews discharge summaries, pathology and diagnostic reports, progress notes, physical exams and physician orders for the ACO REACH members to ensure proper ICD-10,CPT, HCPCs and modifiers are applied
• Queries providers or clinic staff as necessary for clarification of documentation or lack thereof as it pertains to proper application of ICD-10 HCC diagnosis codes
• Identifies and recommends any additional documented HCC diagnosis not coded by provider for reviewed encounters
• Conducts physician chart audits for HCC coding as requested (includes research and presentation of findings and education on correct coding principles)
• Ensures compliance with all applicable federal and state laws and regulations related to coding and documentation guidelines for Risk Adjustment.
• Assists in other projects/duties as assigned

BACKGROUND REQUIREMENTS:

Education, Experience Equivalent to:

• High School Diploma
• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification
• Minimum 2 years of Medicare Risk Adjustment coding
• Epic experience preferred

Skills and Abilities

• Ability to prioritize work
• Accurate data entry
• Advanced knowledge of Microsoft Excel
• Excellent oral and written communication skills
• Excellent interpersonal skills
• Excellent customer service skills
• Ability to maneuver between different software systems
• Must be detail oriented
• Self-driven attitude and ability to work well independently
• Strong organizational and time management skills
• Strong knowledge of ICD-10 and CPT codes
• Strong work ethic with personal qualities of integrity and credibility
• Strong ability to foster relationsips

Physical Requirements

• Frequent use of computer (repetitive fine hand manipulation) and simple grasping of items
• Able to stand at least 75% of the time
• Able to lift, position, push and/or transfer patients
• Able to sit, walk, carry 50 lbs., push, pull, reach, handle, bend, kneel, and crouch
• Has manual and finger dexterity