Risk Adjustment Coder

Overview 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 Details Position: Risk Adjustment Coder Department: Clinical Documentation Schedule: Full Time Responsibilities 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. Review 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. Collaborate 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. Education and Requirements High school diploma or equivalent medical coding education. Associates Degree preferred (or direct work experience equivalent to at least 2 years). Certificates, Licenses, Registrations Coding Certification from AAPC or AHIMA is required. Certifications may include CRC, CPC, CDEO, CCS, CCS-P, CCA, RHIT, RHIA or other relevant credentials. Experience Minimum of two (2) years progressive coding experience in multiple specialties, with HCC risk adjustment coding. Knowledge and Skills Team oriented with emphasis on collaboration and innovation. Experience with an Electronic Medical Record (EMR), EPIC preferred. Knowledge of AHA coding guidelines and methodologies, HCCs and other RA methodologies, ICD-10-CM coding guidelines, OIG and federal/state regulations. Extensive knowledge of medical terminology, anatomy, pathophysiology, pharmacology, and ancillary test results. Strong organizational and analytical skills; detail oriented. Proficient with Microsoft Office applications (Outlook, Word, Excel). Demonstrates critical thinking, able to assess, evaluate, and teach. Self-motivated and able to work independently without close supervision. Strong communication skills (interpersonal, verbal and written). Experience with medical record audits and review; familiarity with external reporting and business aspects of healthcare, including prospective payment systems. Proficient with computer applications and data entry; ability to maintain data integrity and processing accuracy. Excellent organizational skills, including ability to multi-task, prioritize, and meet timelines. Ability to work with accuracy and attention to detail; solve problems using current policies/procedures. Ability to work cooperatively with the healthcare delivery team and staff; handle frequent interruptions and adapt to changes in workload and schedule; respond quickly to urgent requests. Maintain strict confidentiality of all personal/health sensitive information and ensure HIPAA compliance. Compensation Compensation Range: $24.04 - $33.65 per hour This range is an estimate based on minimum qualifications. The offer may consider education, experience, skills, certifications/licensures, internal equity, and market competitiveness. BMCHS offers comprehensive total compensation including benefits, bonuses, and retirement plans. Notes Note: This range is based on Boston-area data and may be modified based on geographic location. Equal Opportunity Employer/Disabled/Veterans. According to the FTC, there has been a rise in employment offer scams. Current job openings are listed on our website and applications are received only through our website. We do not require downloads of applications or offers via text or social media; we do not ask individuals to purchase equipment prior to employment. #J-18808-Ljbffr Boston Medical Center (BMC)