Risk Adjustment Medical Coder

Job Description

Job Description

Description:

Full Time, Remote

Exempt / Salary

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.

Supervisory Relationship:

Reports to: Deputy CFO

Job Summary and Responsibilities

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 of care. Utilizes knowledge of official coding

guidelines, HCC standards, Risk Adjustment Factor (RAF) scoring, and physician query briefs.

Will participate in Provider education on the importance of diagnosis specificity and

documentation guidelines. The Risk Adjustment Coder works to maintain a thorough knowledge

of our current automated eClinicalsWork (eCW) enterprise billing system, through which the

coding and documentation review are functionalized to provide support to HCCH providers and

staffs 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 the work timely; communicate setbacks to deliverables.

and to collaborate with others to meet production and quality standards.

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.

-Other duties as assigned by your Supervisor.

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’s degree in allied health or any related field required.

-Minimum 2 years of progressive Professional Risk Adjustment Coding experience

required.

-Active Certified Risk Adjustment Coder certification (CRC and/or CPC) required

-Candidates hired with active CPC, but without Certified Risk Adjustment Coder

certification (CRC) must obtain CRC certification within 9 months of hire.

Travel Requirements

None.

Salary

Commensurate with experience, education and certifications