Risk Coder Specialist
7 days ago
Company Description
CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.
Role Title: Risk Coder Specialist
FLSA Category: Non-exempt
Role Location: Remote
Reporting Relationships:
This position reports to the Director of Risk Adjustment and Coding Operations.
Role Summary and Responsibilities:
Care360 is a department of CareAbout Health which provides centralized support to our medical practices: care management, care access, care coordination, continuous quality improvement, HCC Coding, etc. We are a growing division with many patient-centered projects which provide continuity of care for patients between office visits to help improve clinical outcomes and patient satisfaction.
The Risk Coder Specialist performs audits and monitoring of clinical documentation analyzing medical records and assessing the accuracy of ICD-10-CM/PCS, E&M, HCC, CPT or HCPCS codes; determines compliance with appropriate policies, procedures, and regulations. Identifies and recommends strategies for process improvement. Prepares written reports on findings. Maintains up-to-date working knowledge on regulatory requirements associated with outpatient and procedure area coding and billing and claims processing. The Risk Coding Specialist will participate in all aspects of the organization’s Compliance Program
Key Responsibilities/Essential Functions:
- Perform internal audits, including the execution of strategic, operational, and compliance risk-based audits for evaluating controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies.
- Conduct medical record documentation and coding/billing audits, assessing the accuracy of ICD-10- CM/PCS, CPT, HCPCS codes, modifier assignments, etc., determining compliance with appropriate policies, procedures, Payor requirements and Federal and state regulations.
- Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
- Assists with creating audit tools to be used to perform the applicable audits of the various types of Providers.
- Prepare comprehensive reports, making recommendations to correct deficiencies and practice or process improvements.
- Interacts with physicians and other patient care providers regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific documentation.
- Interacts with providers and management to review and/or implement codes and to update charge documents.
- Serve as contact for Payor external auditors.
- Generates reports as needed through various systems.
- Assists in provider education.
- Performs miscellaneous job-related duties as assigned.
Non-Essential Functions:
- Other duties, as assigned.
Qualifications:
- High School diploma or GED required; bachelor’s degree preferred.
- 2+ years’ experience in the healthcare field.
- Must have certification through recognized national coding accreditation agency such as American Health Information Management Association or the American Academy Professional Coders: Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P), Certified Professional Medical Coder (CPC), or Professional Medical Coder Outpatient Hospital (COC), CPMA (Certified Professional Medical Auditor).
- Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis (doesn’t replace the necessary AAPC or AHIMA coding certification required).
- Must obtain Certified Risk Adjustment Coder (CRC) certification within 6 months of hire.
- Proficient in Microsoft Office Suite software and Windows 10.
- Knowledge of auditing concepts and principles.
- Advanced knowledge of medical coding and billing systems and regulatory requirements.
- Ability to use independent judgment and to manage and impart confidential information.
- Ability to analyze and solve problems.
- Strong communication and interpersonal skills.
- Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation.
- Knowledge of current and developing issues and trends in medical coding procedures requirements.
- Ability to clearly communicate medical information to professional practitioners and/or the public.
- Detailed knowledge of medical coding systems, procedures, and documentation requirements.
- Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements.
- Ability to provide guidance and training to professional and technical staff in area of expertise.
Physical Requirements:
- Mainly sedentary.
- Sitting at the desk most of the day.
- Standing or walking less than two hours per day.
- Lifting no more than ten pounds on rare occasions.
- Must be able to work at a computer and answer phone calls on a regular basis.
Compensation is based on the level and requirements of the role.
Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.
CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as “protected characteristics”).
We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.
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