Medical Risk Adjustment Coder

Position Summary The Medical Risk Adjustment Coder supports the physician practices and the Care Coordination Department with Coding Improvement activities using various clinical data systems.

Location : Winter Park, Florida Type : Full Time Shift : M-Fri 7 : 00am-4 : 00pm *This is not a remote position Responsibilities

• Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
• Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of
• Identifying and validating reported diagnoses for Medicare / Medicare Advantage and ACO health plan members.
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy,
• Completeness, specificity and appropriateness of diagnosis information.
• Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality measures. .
• Demonstrates analytical and problem-solving ability in the process of reviewing submitted
• Diagnosis codes, comparing to actual services provided to the patient, and communicates appropriate feedback to providers and billing personnel.
• Performs analysis and focused chart reviews for targeted provider education training projects.
• Assists in the acquisition, development and distribution of coding and documentation improvement educational materials.
• Provides articles for the quarterly coding newsletter.
• Facilitates collection, validation, distribution and follow-through support of monthly and quarterly HCC coding reports for allproviders participating in the Managed Medicare Program and Accountable Care Organization Programs.
• Places emphasis on compliance with Risk Adjustment procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
• Coordinates data collection and aggregation on a variety of focused audits and HCC coding capture projects.
• Validates the results of payer audits and translates findings into educational opportunities and tools to optimize revenue recovery.
• Offers support in the Care Coordination Department, focusing on provider and staff education.
• Facilitates ongoing quality metrics monitoring & assists with providing quarterly quality metrics reports for each PCP.
• Performs data validation and integrity functions in a variety of systems pertaining to patient care, clinical documentation, charge entry & billing, and payer claims management.

Qualifications Education / Training High School Diploma or equivalent. Licensure / Certification Must maintain current one of the following : Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Experience Prior HCC / HHS experience with Medicare Risk Adjustment with two (2) years’ experience in medical coding.

Computer literate with skills in Windows, Microsoft Word, Microsoft PowerPoint, Microsoft Excel. Excellent written and verbal communication skills;

ability to write concisely and effectively when communicating with providers.

• Collaborates with a variety of internal and external clients, including health care executives, physicians, provider office personnel, and payer representatives from various health plans to streamline and optimize accurate diagnosis code capture.
• Maintains responsibility for conducting clinical chart and patient billing audits for the purpose of
• Identifying and validating reported diagnoses for Medicare / Medicare Advantage and ACO health plan members.
• Reviews medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• Adheres to all official coding rules and CMS guidelines for risk adjustment, and ensures accuracy,
• Completeness, specificity and appropriateness of diagnosis information.
• Assists with the completion of HEDIS chart reviews and facilitates the accurate and timely reporting of quality measures. .
• Demonstrates analytical and problem-solving ability in the process of reviewing submitted
• Diagnosis codes, comparing to actual services provided to the patient, and communicates appropriate feedback to providers and billing personnel.
• Performs analysis and focused chart reviews for targeted provider education training projects.
• Assists in the acquisition, development and distribution of coding and documentation improvement educational materials.
• Provides articles for the quarterly coding newsletter.
• Facilitates collection, validation, distribution and follow-through support of monthly and quarterly HCC coding reports for allproviders participating in the Managed Medicare Program and Accountable Care Organization Programs.
• Places emphasis on compliance with Risk Adjustment procedures and protocol, internal controls, and maintaining the highest level of workplace behavior.
• Coordinates data collection and aggregation on a variety of focused audits and HCC coding capture projects.
• Validates the results of payer audits and translates findings into educational opportunities and tools to optimize revenue recovery.
• Offers support in the Care Coordination Department, focusing on provider and staff education.
• Facilitates ongoing quality metrics monitoring & assists with providing quarterly quality metrics reports for each PCP.
• Performs data validation and integrity functions in a variety of systems pertaining to patient care, clinical documentation, charge entry & billing, and payer claims management.

Education / Training High School Diploma or equivalent. Licensure / Certification Must maintain current one of the following : Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Experience Prior HCC / HHS experience with Medicare Risk Adjustment with two (2) years’ experience in medical coding.

Computer literate with skills in Windows, Microsoft Word, Microsoft PowerPoint, Microsoft Excel. Excellent written and verbal communication skills;

ability to write concisely and effectively when communicating with providers.