Medicare Risk Adjustment Coding Specialist

4 weeks ago


Miami, Florida, United States Genuine Health Group LLC Full time
Job Summary

Genuine Health Group LLC is seeking a highly skilled Medicare Risk Adjustment Coder to join our team. As a key member of our coding team, you will be responsible for coordinating and 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.

Key Responsibilities:

  • Review patient medical records to determine whether diagnosis codes are supported by documentation and are within guidelines for coding and reporting.
  • Provide clear and concise recommendations and reports to providers and office staff.
  • Submit HCC findings on behalf of providers via submission platform.
  • Conduct full retrospective chart reviews to ensure all HCC opportunities are captured.
  • Implement pre-visit and post-visit audit processes with assigned providers to emphasize capturing all HCCs during patient visits.
  • Build and maintain good working relationships with physicians and office staff.
  • 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.
  • Identify low risk scores, incorrect coding and compliance trends, and analyze and investigate suspected problems to resolve and forward to the Director of Risk Adj & Quality.
  • Must spend minimum 80% of work week visiting Providers onsite at their Practice, in line with Genuine Health's high-touch model.

Requirements:

  • CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification.
  • 3 years of Medicare Risk Adjustment coding experience.
  • 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 LLC 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 LLC 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.



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