Job Summary: The Risk Adjustment Field Coder will be responsible for documentation and coding review of medical records where services are rendered at various partnered medical practices. The Field Coder will work with assigned provider offices to ensure accurate reporting of diagnoses and service codes to support optimal performance in risk adjustment and quality measurement. The scope of work supported by the Field coders will include pre, post and wraparound visit input. Pre-Visit: Reviewing the medical records, outside results and health plan data for upcoming patient appointments and flagging important insights for the provider to review before seeing the patient. Post Visit: review the provider note, populate all supported codes (ICD-10, CPT, CPT-II, etc.), and assist submission of encounter for claim processing. Wrap Around Education- periodic review of findings, highlighting areas of opportunity in documentation and ongoing education. The Field Coder will be responsible for provider querying and education on documentation guidelines. This individual must have a strong understanding and knowledge of CMS Coding and Documentation Guidelines as well as HCC coding practices. The Field Coder will be required to work occasionally onsite at the provider office and may require travel to out of state for in person provider education and training. The Field Coder will be required to maintain consistent and reliable methods of communication to accommodate the hours and demands of providers’ schedules.

Duties and Responsibilities:

• Assign codes to diagnoses and procedures, using ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes
• Ensure codes are accurate and sequenced correctly in accordance with government and insurance regulations
• Refers to clinical coding guidelines and enforces compliance and accuracy at all steps within the review process.
• Query providers to ensure documentation and coding accuracy and compliance
• Audit medical records for risk adjustment and quality measure compliance opportunities
• Perform chart prep to identify care gaps that need to be addressed prior to members’ scheduled appointments
• Communicate to providers care gaps that must be addressed during the visit as well as review documentation post visit to ensure the documentation is compliant
• Reviews and verifies documentation supports diagnoses, procedures and treatment results.
• Serves as a resource to assigned offices and their staff, imparting coding knowledge and expertise to foster a team approach to documentation and coding accuracy. (Will often require being available beyond normal 8-5 working hours, including weekends, to accommodate office and provider hours.)
• Identify opportunities of improvement within the practice, providers, and staff
• Perform in-person/onsite one on one training and education (travel may be required).
• Audits clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes.
• Work with closely with providers on coding and documentation guidelines.
• Conduct group training and education sessions in person or virtual.
• Successfully communicate and liaise with providers and office staff on documentation and coding education
• Audit practice medical records and documentation for HCC compliance following CMS documentation guidelines and best practices.
• Manage and maintain coded data for all PHP members in the assigned office.
• Maintains coding accuracy rate of 95% or greater.
• Maintains coding productivity of 10 chart reviews/hour.
• Work closely with practice billing and coding staff to provide training, support, and ensure reporting is complete and accurate

Requirements:

• High School Diploma, GED or equivalent required
• Minimum of two (2) years’ experience in related field in medical records, claims or billing area is an asset or equivalent combination of education and experience or education.
• Minimum two (2) years in CMS HCC risk adjustment coding.
• Coding certification (CCS or CPC through AHIMA/AAPC) ICD-10 coding proficiency
• Previous medical office experience preferred.
• RHIT and CRC certification preferred.
• Ability to effectively communicate in English, both verbally and in writing.
• Strong Interpersonal & Communication Skills
• Administrative writing skills
• Knowledge of HCC Coding
• Knowledge of HEDIS and Risk Adjustment
• Reporting skills
• Organizational skills
• Ability to maintain a high level of integrity and confidentiality of medical information
• Microsoft Office skills
• Professionalism, confidentiality, and organization

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift

Application Question(s):

• Do have a minimum of two (2) years’ experience in related field in medical records, claims or billing area is an asset or equivalent combination of education and experience or education?
• Do you have a coding certification (CCS or CPC through AHIMA/AAPC) ICD-10 coding proficiency?
• Do you have a minimum one (1) years in CMS HCC risk adjustment coding?

Work Location: One location

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