Risk Coder Specialist

5 days ago

New York, New York, United States CareAbout Full time
Job Title: Risk Coder Specialist Job Summary: CareAbout Health is seeking a highly skilled Risk Coder Specialist to join our team. As a Risk Coder Specialist, you will be responsible for performing 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. You will also determine compliance with appropriate policies, procedures, and regulations, and identify and recommend strategies for process improvement. Key Responsibilities: • 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. Requirements: • 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. Benefits: • Health, dental, and vision insurance. • 401K with automatic employer contribution. • PTO and Paid Holidays. • Company paid Life Insurance. • Access to voluntary short and long-term disability insurance. • Access to additional life insurance. • Access to a variety of Wellness programs. Equal Opportunity Employer: 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). Salary Range: $23/hr - $33/hr 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.

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