Medical Risk Adjustment Coder
Administrative | Gastonia, NC | Full Time
Summary of Position: With oversight from the Director of Revenue Cycle, The Medical Risk Adjustment Coder Specialist reviews medical records for proper documentation and diagnosis coding to ensure the capture of all relevant codes based on the CMS - Hierarchical Condition Categories, as outlined in the CMS Risk Adjustment Model and delivers direct oversight to the Medical Coder. Additional responsibilities include medical coding and billing corrections for Kintegra Health ambulatory care services, including office, outpatient and ancillary services. The Medical Coder will understand ICD-9, ICD-10, CPT and HCPCS coding; can interpret insurance guidelines relative to medical coding; understand daily balancing techniques; understand abbreviations and medical terminology; can read a medical chart; and be able to understand the basic components of medical and ancillary procedures.
Minimum Qualifications and required Skills
Knowledge of Medical Record content for outpatient visits.
Knowledge of medical terminology, anatomy & physiology
Organized and attention to detail and quality.
Ability to prioritize workload and strong recall and recognition skills.
Ability to perform computer functions in a Microsoft Applications.
Good verbal, written and computer communication skills.
A valid NC driver’s license with the ability to travel between sites
AAPC Certified Professional Coder (CPC) and AAPC Risk Coding Certification (CRC) is required.
CDIS/P (Clinical Documentation Improvement Specialist or Practitioner) status through AHIMA or ACDIS is advantageous.
Graduate of approved HIA or HIT program or equivalent, preferred
Licensure: Current CPC, CRC and/Current RHIA or RHIT
Minimum of 3-years of experience in coding and/or auditing of medical records.
Coding skills with experience in ICD-10-CM and working in primary care ambulatory care settings.
Knowledge of Commercial, Medicare and Medicaid (NC) coding and documentation guidelines.
Key Responsibilities (10-Core)
Review medical records noting the specific medical diagnoses assessed, coded, and billed, primarily on comprehensive outpatient encounters.
Understand Annual Wellness Visits, Transitional Care Management Visits and the required documentation standards.
Validate the presence or absence of supporting documentation within the medical record.
Determine whether the most specific and accurate ICD-10 codes were selected by the provider.
Document the findings of all chart reviews for future reference in education sessions.
Respond to and correct coding errors within 30-days to vendors.
Identify missed opportunities for HCC codes and provide alternative (more accurate and more specific) codes with valid reasoning.
Participate in provider education when appropriate.
Collaborate with Data Analysts and Operations team members.
Other duties as assigned.