Risk Adjustment Coder

This position is responsible for ongoing risk adjustment improvement activities Under general supervision this position includes ongoing quality improvement activities to ensure the organization s Risk Adjustment programs are implemented and meet all government requirements.

NATURE AND SCOPE
This role does not manage people
This job reports to: Departmental Leadership
Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:

All levels of Client Personnel; physicians and their office personnel; hospitals and allied health provider administration, personnel and third-party medical record vendors; other Blue Plans; Client Association and contracted vendors

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QUALIFICATIONS
Education
High School Diploma or GED required
Work Experience
3 years of medical coding experience required with experience in risk adjustment preferred
1 year medical coding audit experience preferred

Skills and Abilities
Knowledge base of clinical standards of care, preventive health standards and Risk Coding.
Ability to evaluate medical records with attention to detail
Knowledge of ICD-10 Guidelines
Ability to understand CMS Risk Adjustment guidelines
Must have the ability to travel up to 20%
Licenses and Certifications
CRC, CPC or CCS required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Under limited supervision review and assess documentation and accurately translate chronic conditions into the appropriate diagnosis code from inpatient and outpatient medical records
Enter coding results into database
Maintain 95% coding accuracy on all coding projects
Perform second level coding review to ensure accuracy and limit fraud, waste, and abuse
Monitor submission for coding trends and provide feedback to coders regarding coding errors and trends
Perform annual coding and documentation training to staff and providers
Disperse Risk Adjustment Gap report to providers and facilities
Other duties may be assigned to meet the needs of the organization
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.