Copy of Risk Adjustment Coder
Jobgether
- United States
- Remote
- Full-time
- Mid Level
- Posted
This
position
is
listed
on
behalf
of
a
partner
company,
who
manages
all
applications
and
next
steps.
Our
partner
is
looking
for
a
Copy
of
Risk
Adjustment
Coder
based
in
the
United
States
.
The
Risk
Adjustment
Coder
will
play
an
important
role
in
improving
healthcare
documentation
accuracy
and
supporting
high-quality
primary
care
for
Medicare-eligible
patients.
This
position
focuses
on
prospective,
retrospective,
and
concurrent
medical
record
reviews
to
ensure
diagnoses
are
accurately
documented
and
coded
in
accordance
with
regulatory
guidelines.
You
will
work
closely
with
physicians
and
clinical
teams
to
identify
coding
opportunities,
address
documentation
gaps,
and
strengthen
risk
adjustment
processes.
Through
regular
provider
education
and
collaboration,
you
will
help
improve
coding
accuracy,
compliance,
and
patient
care
outcomes.
The
role
combines
strong
technical
coding
expertise
with
communication
and
analytical
skills
in
a
collaborative,
patient-centered
healthcare
environment.
This
is
an
opportunity
to
contribute
to
better
healthcare
delivery
while
supporting
underserved
senior
communities.
Accountabilities:
Review
patient
medical
records,
including
medical
histories,
physical
examinations,
physician
orders,
progress
notes,
consultation
reports,
diagnostic
results,
operative
reports,
discharge
summaries,
and
other
clinical
documentation.
Perform
prospective,
retrospective,
and
concurrent
chart
reviews
using
Hierarchical
Condition
Category
(HCC)
risk
adjustment
coding
guidelines
and
M.E.A.T.
criteria
to
validate
diagnosis
accuracy
and
documentation
support.
Conduct
pre-visit
and
post-visit
audits
with
assigned
providers
to
ensure
diagnoses
are
accurately
captured
and
documented
at
the
highest
appropriate
level
of
specificity.
Establish
and
maintain
strong
working
relationships
with
physicians
and
clinical
office
staff
through
regular
communication,
follow-ups,
and
scheduled
chart
review
meetings.
Obtain
medical
records
from
internal
and
external
healthcare
providers
to
support
accurate
documentation
and
respond
to
health
plan
audit
requests.
Educate
physicians
and
administrative
staff
on
appropriate
coding
practices,
billing
requirements,
documentation
standards,
and
the
resolution
of
ambiguous
or
incomplete
medical
records.
Identify
missing
documentation,
coding
opportunities,
inaccurate
diagnoses,
and
potential
compliance
issues,
investigating
discrepancies
and
escalating
concerns
when
necessary.
Conduct
onsite
provider
visits
to
deliver
coding
education,
share
chart
review
feedback,
and
promote
continuous
improvements
in
documentation
quality.
Ensure
compliance
with
applicable
federal,
state,
and
local
regulations,
as
well
as
risk
adjustment
coding
standards
and
reporting
requirements.
Support
accurate
CPT,
HCPCS
Level
II,
ICD-10-CM,
and
modifier
coding,
while
applying
knowledge
of
HEDIS
codes
and
NCQA
guidelines.
Meet
established
daily
productivity
targets
while
consistently
maintaining
an
average
coding
accuracy
rate
of
at
least
95%.
Perform
additional
responsibilities
as
assigned
to
support
the
broader
clinical
and
operational
teams.
Requirements:
High
school
diploma
or
associate
degree
required.
Clinical
education
or
professional
background
as
an
RN,
LVN,
LPN,
foreign
medical
graduate,
or
pharmacist
is
preferred.
At
least
3
years
of
professional
experience
in
ICD-10
coding.
Minimum
of
3
years
of
experience
in
Medicare
risk
adjustment
coding.
At
least
2
years
of
experience
conducting
prospective,
concurrent,
and
retrospective
risk
adjustment
reviews.
Minimum
of
1
year
of
experience
providing
coding
and
documentation
education
to
healthcare
providers.
At
least
1
year
of
experience
with
CPT
and
Evaluation
and
Management
(E&M)
coding.
At
least
1
year
of
How Jobgether works
- We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
- We appreciate your interest and wish you the best!
- Why Apply Through Jobgether?
Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.
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