Medical Risk Adjustment Coding Specialist

4 weeks ago


Charleston, South Carolina, United States FETTER HEALTH CARE NETWORK INC Full time
Job Summary

We are seeking a highly skilled Medical Risk Adjustment Coding Specialist to join our team at Fetter Health Care Network Inc. This role will play a critical part in our billing and value-based care process, ensuring accurate and compliant coding practices.

Key Responsibilities
  • Oversee hierarchical condition category (HCC) coding and ensure compliance with regulatory requirements.
  • Collaborate with the Quality Department to complete Risk Adjustment data validation and identify Value-Based Program requirements.
  • Review and assign accurate CPT, HCPCS, CPTII ADA, and ICD-10 codes for diagnoses, procedures, and evaluation and management services.
  • Perform regular retrospective documentation and coding reviews to ensure providers adhere to documentation and coding guidelines.
  • Document all coding changes made within the eCW system and notify providers via the eCW messaging system.
  • Serve as an organization-wide resource for coding-related inquiries and provide ongoing training to staff.
  • Process assigned charge sessions and review claims for services rendered to ensure proper billing for reimbursement.
  • Account for coding and abstracting of patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
  • Research and analyze data needs for reimbursement and identify discrepancies, potential quality of care, and billing issues.
  • Recommend and facilitate plans of action to correct discrepancies and prevent future coding errors.
Requirements
  • High School Diploma required; Associate degree or higher preferred.
  • Medical terminology knowledge preferred; Electronic medical records experience strongly preferred.
  • Valid Drivers' License required.
  • CPC, CRC CPC-P, or CCS-P certification required.
Working Conditions
  • Administrative Office Setting; Exposure to communicable diseases, blood, and other bodily fluids.
  • May attend meetings, seminars, and speaking engagements locally and out of state.


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