Risk Adjustment Medical Coder (Remote) ID-7731

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Organization

High Country Community Health (HCCH) is a federally funded Community and Migrant Health Center with medical locations in Watauga, Avery, Burke, and Surry Counties. The mission of HCCH is to provide comprehensive and culturally sensitive primary health care services that may include dental, mental and substance abuse services to the medically under-served population of Watauga, Avery, Burke, and Surry Counties and the surrounding rural communities.

Job Summary and Responsibilities

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The Risk Adjustment Medical Coder provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and patient complexity. Utilizes knowledge of official coding guidelines, HCC standards, Risk Adjustment Factor (RAF) scoring, and physician query briefs. May participate in Provider education on the importance of diagnosis specificity and documentation guidelines. The Risk Adjustment Coder works to maintain a thorough knowledge of the automated eCW billing system through which the coding and documentation review are functionalized to provide support to HCCH providers and staff as necessary. Provides subject matter expertise to others including staff in the Billing department as necessary. This position requires professional maturity, responsibility, integrity, and subject matter expertise to complete timely and communicate setbacks to deliverables, exercise professional communication with physicians and supervisors, and collaborate with others to meet production and quality standards. This opportunity may be the next step in your career as a Medical Coder.

Responsibilities include:

  • Review and accurately code medical records and encounters for diagnoses and procedures related to Risk Adjustment and HCC coding guidelines
  • Validate and ensure the completeness, accuracy, and integrity of coded data.
  • Concurrently, prospectively, and retrospectively review medical records to identify unclear, ambiguous, or inconsistent documentation ensuring full capture of severity, accuracy, and quality.
  • Query providers when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
  • Utilizes approved resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS and ensures documentation in the medical record follows official coding guidelines, internal guidelines, and AHIMA physician query brief standards.
  • Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines.
  • Comply with HIPAA laws and regulations.
  • Maintain coding quality and productivity standards set forth by HCCH.
  • Maintain competency in evolving areas of coding, guidelines, and risk adjustment reimbursement reporting requirements.
  • Assist in internal and external coding audits to ensure the quality and compliance of coding practices.
  • Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education and support for improvement in HCC coding, and RAF scoring.
  • Assist with educational in-services for physicians, other providers, and clinic staff relating to coding and documentation compliance as well as new policies and procedures relating to clinical documentation compliance related to billing.
  • Maintains complete confidentiality of patient information.
  • Assists with developing, implementing, and reviewing policies, procedures, and forms related to areas of responsibility.

Requirements/Skills/Experience

  • High-speed internet access
  • Strong clinical knowledge related to chronic illness diagnosis, treatment, and management.
  • Knowledge and demonstrated understanding of Risk Adjustment coding and data validation requirements is highly preferred.
  • Personal discipline to work remotely without direct supervision
  • Dental coding skills a plus
  • Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical chart documentation.

Qualifications:

  • Bachelor or associate degree in allied health or any related field preferred, but not required.
  • Active Certified Coder certification (CPC and/or CRC) preferred
  • Candidates hired without Certified Professional Coder (CPC), and/or Certified Risk Adjustment Coder (CRC) must obtain certification within 9 months of hire.
  • Minimum 2 years of Professional Coding experience, with progressive Risk Adjustment coding experience in Hierarchical Condition Category (HCC)

Risk Adjustment Medical Coder (Remote) ID-7731

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