Coder

Overview

• Join a dynamic healthcare organization as a Risk Adjustment Coder, ensuring accurate clinical data for Medicare risk adjustment coding.
• Collaborate with healthcare providers to enhance documentation practices and compliance with coding guidelines.
• Contribute to quality improvement initiatives by identifying documentation and coding process enhancements.
• Stay updated on industry changes and Medicare regulations through continuous education and training.
• Utilize Encoder Pro/Optum products to streamline coding processes and ensure accuracy.
• Work in a hybrid environment with flexible office attendance requirements.
• Support the organization's mission to deliver exceptional care to members through precise coding practices.

Key Responsibilities & Duties

• Conduct thorough reviews of medical records to ensure accurate risk adjustment coding.
• Apply ICD-10-CM and HCC coding guidelines for Medicare beneficiaries.
• Collaborate with clinical staff to educate on documentation practices and compliance.
• Identify areas for improvement in coding and documentation processes.
• Generate coding reports and provide feedback to medical staff.
• Participate in training sessions to stay informed on industry changes.
• Support quality improvement initiatives to enhance coding accuracy and compliance.
• Collaborate with teams to develop processes for appropriate utilization and closing gaps in care.

Job Requirements

• Bachelor of Science degree required, with certification as a professional coder (CPC or CCS-P).
• Minimum of 1 year of experience in risk adjustment coding, preferably in healthcare plans or hospitals.
• Proficiency in ICD-10 code sets and familiarity with Encoder Pro/Optum products.
• Intermediate skills in Excel, MS Word, and Access for data entry and reporting.
• Strong ability to interpret documents and communicate effectively with physicians and team members.
• Knowledge of risk adjustment methodologies and Medicare regulations.
• Experience in identifying and addressing areas of over or under-utilization in coding practices.
• Commitment to continuous learning and professional development in coding practices.