HCC Risk Adjustment Medical Coder Specialist

Job Family:

Medical Records

Travel Required:

None

Clearance Required:

None

What You Will Do:

The HCC Risk Adjustment Medical Coder Specialist ensures the data integrity of coded patient records by reviewing the submitted medical documentation and validating that it accurately supports the assigned codes while following the Official Guidelines for Coding and Reporting, AHA coding clinics, CMS/MAC program guidance, internal policies and procedures and in accordance with all state and federal regulations. This position will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate HCC related ICD-10 Diagnosis codes.  The HCC Coder will have the ability to identify encounter level discrepancies and documentation improvement opportunities for provider education, as well as identifying and communicating trending issues.   The HCC Coder will query providers regarding missing, unclear or conflicting documentation utilizing designated query process.

Responsibilities:

• Demonstrates the ability to perform quality coding on ancillary charts, clinic charts, and emergency room records.
• Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing.
• Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, seeks to attain proper documentation in a timely manner according to facility standards.
• Achieves and maintains 95% accuracy in coding while maintaining a high level of productivity. Accuracy will be monitored during monthly reviews either within the facility.
• Maintains average productivity standards
• Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary.
• Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process.
• Works directly with the IQC staff to ensure quality standards are being met for each facility.
• Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request.
• Coders must maintain their current professional credentials while working for Guidehouse.
• Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy)
• Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services.
• Communicates problems or coding principle discrepancies to their supervisor immediately.

What You Will Need:

• Minimum 3-5 years professional coding experience in HCC Risk Adjustment Coding.

• 2-3 years previous professional coding experience in HCC Risk Adjustment Coding

• 2-3 years previous general or multi-specialty coding experience

• CPC and CRC Certification

• High School Diploma or equivalent

• EMR Experience

• Basic knowledge of Excel , Word and PowerPoint

• High level of accuracy

• Strong Working Knowledge & experience with Federal & State Coding regulations and Guidelines

• Excellent verbal, written and interpersonal communication skills

What Would Be Nice To Have:

• NextGen Experience

• Cerner Experience

• ECW Experience

• Previsit Risk Adjustment planning methodology experience

• CMA or LPN Certification

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The annual salary range for this position is $52,500.00-$78,700.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term &am