Certified Risk Adjustment Coder

Demonstrates knowledge of coding and documentation standards as well as CMS risk adjustment guidelines and HCCs (hierarchical condition categories)

Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care

Regularly reviews Epic HCC and payor CSI (Clinically Suspect Conditions) reports

Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding

Demonstrates understanding of risk adjustment payment models

Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently

Completes patient medical chart review within 24-48 hours of visit completion

Responsible for maintaining active status of coding credentials and completes annual continued education hours.

Observes work hours and provides proper notice regarding absences and tardiness

Maintains positive working relationship with Physician Practices, Managed Care and all other departments and communicates with office staff as needed.

Performs other related duties.

CPC, CCS-P or CRC Certification Required

High School graduate

Five plus years experience in Coding and Billing, Knowledge of ICD-10-CM and CPT