Risk Adjustment Coder II

2 weeks ago


Atlanta, Georgia, United States Point32Health, Inc. Full time

About the Job and the Company

New Opportunity at Point32Health
Join our great team at Point32Health, a leading health and wellbeing organization dedicated to providing personalized healthcare experiences to our communities. We are a nonprofit organization with a strong foundation from Tufts Health Plan and Harvard Pilgrim Health Care. Our mission is to help people achieve healthier living through a variety of health plans and tools.

Job Summary
Reporting to the Risk Adjustment Supervisor/Manager, you will play a crucial role in reviewing and validating Medicare Advantage, Commercial, and Medicaid HCCs through medical record reviews. Your responsibilities will include ensuring coding accuracy, evaluating HCC coding practices, and providing feedback to enhance provider documentation and coding.

Key Responsibilities/Duties - What You'll Be Doing
- Conducting audits on medical records to verify diagnosis coding accuracy
- Collaborating with staff and vendors to address coding adjustments
- Keeping up-to-date with coding rules and CMS guidelines
- Researching and resolving coding questions and regulatory issues
- Providing expertise to evaluate coding programs
- Reviewing reports, identifying coding issues, and making recommendations

Qualifications - What You Need
- Completion of a formal coding certification program required
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification required
- 5 years of coding experience preferred
- Understanding of medical terminology and coding guidelines
- Strong computer skills and ability to work independently
- Excellent problem-solving and interpersonal skills
- Ability to write clearly and communicate effectively with various stakeholders

Compensation & Total Rewards Overview
As part of our total rewards program, you'll have access to medical, dental, and vision coverage, retirement plans, paid time off, and more. Point32Health offers a competitive package that supports career development and overall well-being.

Commitment to Diversity, Equity, Inclusion, Accessibility, and Health Equity
At Point32Health, diversity, equity, inclusion, accessibility, and health equity are integral to our operations and workforce culture. We are dedicated to fostering an inclusive environment and providing equal opportunities for all candidates. Join us in driving innovation and promoting a diverse and talented workforce.



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