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Medicare Risk Adjustment Coder
4 months ago
Summary:
The Medicare Risk Adjustment Coder will be responsible for coordinating/supporting retrospective and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract and validate medical record data. With the focus on achieving year over year improvement on Risk Adjustment coding and documentation.
Essential Duties and Responsibilities:
- Review all available patient medical records: Medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries and any other available medical records. Determine whether the diagnosis codes are supported by the documentation and are within the guidelines for coding and reporting (M.E.A.T).
- Provide recommendations in clear and concise fashion and provide reports directly to provider and or office staff.
- Submit HCC findings on behalf of the providers via submission platform.
- Full retrospective chart review on beneficiaries two times a year, beginning and end of year, to ensure all HCC opportunities are captured.
- Implement a pre-visit and post visit audit process with assigned provider that emphasizes on capturing all HCCs during patient visit.
- Engage physicians and office staff to build and maintain a good working relationship.
- Ensure frequent touchpoints with your assigned provider groups and schedule meetings to discuss chart review with your assigned provider.
- Assist in obtaining medical records from internal and external providers to ensure maximum risk adjustment is captured and to support audits requested by Health Plans.
- Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment.
- Educate physicians and supporting office staff on proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
- Demonstrate the ability to quickly identify low risk scores; incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and to forward problems to the attention of the Director of Risk Adj & Quality.
- Must spend minimum 80% of his/her work week visiting Providers onsite at their Practice, in line with Genuine Health's high-touch model.
- Other duties as assigned.
Knowledge, Skills and Abilities
- Strong verbal and written communication skills.
- Strong organizational skills and attention to detail.
- Strong collaboration and relationship building skills.
- Ability to work and problem-solve with minimal supervision; ability to adapt to change positively in workflow and process.
- Proficient in Microsoft Outlook, Excel, and other web-based software.
- Ability to communicate effectively and work with cross functional teams.
- Ability to work independently.
Minimum Education and Experience
- CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification.
- 3 years of Medicare Risk Adjustment coding.
- FMG or International Medical Graduate preferred
- Previous experience using electronic medical record systems.
- Strong knowledge of ICD-10 and CPT codes.
- Bilingual: Spanish and English.
Genuine Health Group offers a competitive compensation and benefits package that includes a 401k matching program, fully subsidized medical plans, paid holidays and much more. Base salary will be commensurate to professional experience.
Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
