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Risk Adjustment Coder

5 months ago

Houston, United States Apex Health Solutions Full time
Job DescriptionJob Description

SUMMARY:

Risk Adjustment Coder is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements.

Reports to: AVP, STARs & Risk Adjustment

Location: Houston, TX

EDUCATION:

• High School Diploma or GED Required

LICENSES/CERTIFICATIONS:

A certification in one of the following is required:

• Certified Risk Adjustment Coder (CRC)

• Certified Professional Coder (CPC)

• Certified Coding Specialist (CCS)

EXPERIENCE:

• Minimum of three (3) years HCC experience performing retrospective risk adjustment chart review required.

• Minimum of three (3) years of experience in a hospital, a physician setting or a Managed Care Organization as a

medical coder.

• Minimum of five (5) years ICD-9 CM/ ICD-10 CM coding experience required.

• Current AAPC or AHIMA credential required.

• Managed Care Experience preferred.

• Knowledge of Medicare Risk Adjustment required.

SKILLS:

• Knowledge of healthcare delivery

• Strong oral and written communication skills.

• Ability to work in a fast-paced environment with changing priorities.

• Ability to work with others in a matrixed environment.

• Demonstrated written communication skills.

• Demonstrated time management and priority setting skills.

• Demonstrated problem solving skills.

• Demonstrated organizational skills.

RESPONSIBILITIES:

• Follows CMS Risk Adjustment guidelines and has a complete understanding of these guidelines.

• Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS

standard requirements for valid submission.

• Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD10-CM coding classification systems.

• Selects and accurately records all appropriate records and data on assigned chart abstraction projects.

• Ability to meet productivity and accuracy standards.

• Tracking and monitoring of medical records requests for all risk adjustment projects.

• Performs telephonic outreach to provider practices and/or facilities to request medical records.

• Performs other duties as assigned.

TECHNICAL SKILLS:

• Working knowledge of Microsoft Office

• Working knowledge of Electronic Health Records (EHR)

ABOUT APEX HEALTH SOLUTIONS

Apex Health Solutions powers payers and providers choosing to engage in value-based risk contracting. Apex’s unique

solutions create alignment between payers and providers, generating unparalleled value. Combined with Apex’s experienced and successful industry leadership, our focal point remains on improvement in patient quality, satisfaction and overall cost of care.