Risk Adjustment Coder

📁
Manager & Professional
💼
EmblemHealth
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Review supplied medical records to determine if diagnosis codes are properly mapping to HCCs Government (CMS, HHS, State) documentation guidelines.  Assist with chart retrieval and coding vendors to execute the HCC Data Confirmation Program.Support the HCC Coding manager on Vendor coding validations with SLAAssist in other initiatives and projects as needed. Maintain a 95% or better coding accuracy through routine performance reviews.


Responsibilities:

  • Comply with all legal requirements regarding coding procedures and practices
  • Evaluate each medical record to ensure that M.E.A.T. criteria support the existence of all submitted diagnosis codes
  • Identify, assess and delete submitted diagnosis codes for CMS submission requirements.
  • Working with HCC Coding Manager and with external vendors to ensure complete and accurate analysis of system codes.    
  • Work with HCC Coding manager to drive external vendors to an in-house function.
  • Work with HCC Coding Manager to address any coding adds/edits/deletes
  • Work with HCC Director and Coding manager to support the Enterprise Risk Adjustment HCC Data Confirmation Program.    
  • Identify diagnosis conditions that will support coding education sessions for the provider community to improve risk adjustment coding. 
  • Monitor, analyze and assist HCC Coding Manager to prepare reporting of coding results overall and by provider.
  • Regularly meet with HCC Director and Coding Manager to share results of specific coding activities. 
  • Maintain industry coding knowledge, certifications and enterprise wide CMS coding compliance SME.    
  • Assist in other initiatives and projects as needed.     
     

Qualifications:

  • Bachelor’s Degree
  • Required certifications: Risk Adjustment Coder (CRC); Professional Coder (CPC)
  • 2-3 years of related work experience (R)
  • Additional experience/specialized training may be considered in lieu of educational requirements (R)
  • Experience with working in a compliance related function across a large division, department, or company (R)
  • Self-starter with ability to work with multiple levels of management and handle multiple tasks successfully  (R) 
  • Prior experience working with external vendors (R)
  • Proven track record of collaboration and coordination across all levels and areas/divisions of provider organizations (R) 
  • Effective communications skills (verbal and written) with all types and levels of audiences (R) 
  • Proficiency with MS Office applications (word processing, spreadsheet/database, presentation) (R)
  • Energetic and enthusiastic with a positive attitude (R) 
  • Knowledge of healthcare operational processes and products (P)
  • Excellent analytical skills (R)
  • Proficiency with computer and data entry retrieval skills (R) 
  • Experience with HCC Model, ACA model and Medicaid model  (R)

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