Risk Adjustment Coder

POSITION SUMMARY: The Risk Adjustment Coder determines the appropriate ICD10-CM diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for risk adjustment and Hierarchical Condition Categories (HCC). Risk adjustment coding relies on ICD-10-CM coding to assign risk scores to patients. The incumbent reviews retrospective medical record documentation and ensures that the codes are appropriately assigned. The outcome will be documentation that accurately and completely captures the clinical picture/severity of illness/complexity of the patient while providing specific and complete information to be utilized in coding, profiling and outcomes reporting of both the facility and the physicians. The Risk Adjustment Coder utilizes standards of compliance, specifically in OP compliant query processes and clinical knowledge to identify opportunities and to achieve results Also required is advanced knowledge of CPT, ICD-10-CM, and HCPCS coding systems. Position: Risk Adjustment Coder Department: Clinical Documentation Schedule: Full Time ESSENTIAL RESPONSIBILITIES / DUTIES: Review documentation available in the Medical Record to facilitate workflows that support the clinical picture/severity of illness/complexity of the patient care rendered to patients. Reviews medical records to ensure accurate codes are applied to the encounter. Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs or other RA methodologies Actively participate in and maintain coding quality and productivity processes Collaborates with nursing or coding staff on retrospective medical record review for severity, accuracy, and quality issues. Ensure documentation in the medical record follows the official coding guidelines, internal guidelines and the AHIMA/ACDIS physician query brief. Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities. Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. 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 related to billing. Participate in training new coding staff, as needed. IND123 JOB REQUIREMENTS EDUCATION: High school diploma or equivalent medical coding education. Associates Degree preferred (or direct work experience equivalent to at least 2 years) CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED: Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required EXPERIENCE: Minimum of two (2) years progressive coding experience in multiple specialties, HCC Risk adjustment Coding KNOWLEDGE AND SKILLS: Willing to work as a team – innovation and collaboration is a priority Experience with an Electronic Medical Record (EMR), EPIC preferred Knowledge of AHA coding guidelines and methodologies: HCC’s and other RA methodologies, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results Strong organization and analytical thinking skills – detail oriented Proficient with Microsoft Office applications (Outlook, Word, Excel) Demonstrates critical thinking skills, able to assess, evaluate, and teach Self-motivated and able to work independently without close supervision Strong communication skills (interpersonal, verbal and written) Medical Record audits and review Familiarity with the external reporting aspects of healthcare Familiarity with the business aspects of healthcare, including prospective payment systems Proficient with computer applications (MS Office etc.), Excellent data entry skills Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required. Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines. Ability to work with accuracy and attention to detail Ability to solve problems appropriately using job knowledge and current policies/procedures. Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests. Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations. Compensation Range: $24.04- $33.65 This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being. NOTE: This range is based on Boston-area data, and is subject to modification based on geographic location. Equal Opportunity Employer/Disabled/Veterans According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment. Working at Boston Medical Center is more than a job. It’s a chance to make a difference as part of our mission to provide exceptional and equitable care to all. As a nationally-recognized leader in health equity, nursing, initiatives to combat climate change, and many other areas, BMC is dedicated to improving the health of our community in Boston and beyond. BMC’s mission to provide exceptional care without exception extends to our employees, and we have been recognized as a top employer and best place to work. A strong sense of teamwork and support for our staff are the bedrock of BMC, as we know that we can only provide exceptional care to patients when our staff are cared for too. Boston Medical Center is an equal employment/affirmative action employer. We ensure equal employment opportunities for all, without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic. If you need accommodation for any part of the application process because of a medical condition or disability, please send an e-mail to View email address on click.appcast.io or call View phone number on click.appcast.io to let us know the nature of your request. Boston Medical Center participates in the Electronic Employment Verification Program. As an E-Verify employer, prospective employees of BMC must complete a background check before beginning their employment at the hospital. BMC requires all staff to be vaccinated against COVID-19 and flu, as well as receive a booster dose of the COVID-19 vaccine. According to the FTC, there has been a rise in employment offer scams. Our current job openings are listed on our website and applications are received only through our website. We do not ask or require downloads of any applications, or “apps” job offers are not extended over text messages or social media platforms. We do not ask individuals to purchase equipment for or prior to employment. To avoid becoming a victim of an employment offer scam, please follow these tips from the FTC: FTC Tips