Job Summary:

The Risk Adjustment Coder & Educator is responsible for providing expertise in the area of risk adjustment coding for assigned provider groups. This includes reviewing medical records and identifying, collecting, assessing, monitoring, and documenting claims and encounter information as it pertains to risk adjustment for both Medicare and Commercial patient populations. The Risk Adjustment Coder & Educator interacts with Value Based Care (VBC) leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and coding.

(This is a full-time position Monday to Friday 8 am to 5 pm)

Primary Job Responsibilities/Tasks may include, but not limited to:

Primary Responsibilities:

• Provides guidance and consultation to assist providers in understanding Risk Adjustment coding as it relates to payment methodology and the importance of proper chart documentation of diagnosis codes
• Educates providers about the CMS - HCC Risk Adjustment driven payment methodology and the importance of proper chart documentation of procedures and diagnosis coding, in accordance with Tryon Risk Adjustment Coding policy
• Supports the providers by ensuring documentation supports the submission of relevant ICD -10 codes and CPTII procedural information in accordance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines.
• Routinely consults with providers to clarify missing or inadequate record information to determine appropriate diagnostic codes and obtain additional medical record documentation as needed for accurate coding
• Provides thorough, timely and accurate consultation on ICD-10 and CPT II codes by providers or practice clinical consultants
• Provides ICD10 - HCC coding training to new providers and appropriate staff
• In conjunction with VBC leadership and Compliance, facilitates education and/or educates providers on proper Risk Adjustment coding and medical record review criteria
• Develops and delivers diagnosis coding tools to providers, including presentations and trainings provided to co-workers, management and other practice staff as needed.
• Uses results from clinical validation audits to identify trends and improvement opportunities; documents follow-up education provided
• Assesses adequacy of documentation and queries providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding
• Effectively manages special Risk Adjustment coding projects and other tasks as assigned
  
  

Required Qualifications:

• 3+ years of clinic or hospital experience and / or managed care experience
• 3+ years of experience in Risk Adjustment with proficiency in ICD-10and CPT coding
• Certified Risk Adjustment Coder AND / OR Certified Professional Coder with the American Academy of Professional Coders with the requirement to obtain both certifications, CRC and CPC, within first year in position - (CRC within 6 months of hire and CPC within 1 year of hire)
• Proficient in MS Office (Excel (Pivot tables, excel functions), PowerPoint and Word)
• Experience working effectively with common office software, coding software, EMR and abstracting systems
• Excellent verbal and written communication skills
  
  

Preferred Qualifications:

• Bachelor’s degree
• Knowledge of EMR for recording patient visits
• Experience coding in a health care facility
• Knowledge of billing / claims submission and other related activities
  
  

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling
• Must be able to lift and support weight of 35 pounds
• Ability to concentrate on details
• Use of computer for long periods of time
  
  

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