Certified Risk Adjustment Coder Senior

Department CC019053 Population Health Clinical Ops Position Responsibilities Demonstrates knowledge of coding and documentation standards as well as CMS Risk Adjustment Program guidelines and HCCs (hierarchical condition categories). Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care. Regularly reviews Epic HCC and payer reports. Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding. Demonstrates understanding of risk adjustment payment models. Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently. Completes patient medical chart review upon visit completion by protocol, using the hospital resources (i.e. EPIC, Care Everywhere and Suspects reports provided by the Health plan). Performs coding and abstracting with an accuracy rate higher than 95%. Maintains log of activities as required for weekly and/or monthly reports (i.e. productivity and time management reports). Provides the primary source of data and information used in health care. Promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement. Maintains effective interpersonal skills and positive working relationship with co-workers and physicians. Promotes clear and accurate communications among the working team and with other related parties. Maintains information organized and ready for easy and quick access. Assists IMED physicians in understanding the CMS HCC Risk Adjustment Program as it relates to payment methodology and the importance of proper medical documentation of procedures and diagnosis coding. Assists providers and other professional staff in retrieving and compiling data for research, diagnosis, and teaching purposes. Utilizes analytics, identifies and target IMED physicians for Medicare Risk Adjustment training and documentation/coding resources. Other duties as assigned. Qualifications License/Registration/Certification CRC, CDEO, CPC, CPMA Certifications Required. Education High school graduate. Experience Five plus years’ experience in Coding and Billing, Knowledge of ICD-10-CM and CPT. Benefits Health benefits Life insurance Long-term disability coverage Healthcare spending accounts Retirement plan Paid time off Pet Insurance Tuition reimbursement Employee assistance program Wellness program On-site housing for select positions #J-18808-Ljbffr Mount Sinai Medical Center