Risk Adjustment Coder

2 weeks ago

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

Position Summary: Apex Health Solutions is expanding our services by building a member concierge team to assist our client’s health plan members with onboarding processes and questions. This position will be one of the initial points of contact with our client organization membership and shall provide initial onboarding through a disciplined flow of call scripting. Individuals within this team will also be responsible for ongoing outreach on a predetermined cadence to enrich the overall member experience.

Essential Duties and Responsibilities:

  • 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.
  • 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.​​​​​​
Qualifications: ​​
  • 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.
  • Working knowledge of Microsoft Office
  • Working knowledge of Electronic Health Records (EHR)

Education/Licenses/Certifications: ​A certification in one of the following is required:

  • Certified Risk Adjustment Coder (CRC)
  • Certified Professional Coder (CPC)
  • Certified Coding Specialist (CCS)
  • High School Diploma or GED Required

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.

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