Cert. Risk Adjustment Coder

Job Summary:

The Certified Risk Adjustment Coder accurately codes, sequences, abstracts and audits outpatient medical records according to ICD-10-CM, CPT coding guidelines and abstracts supported HCC (Hierarchical Condition Category Coding) diagnosis codes that are clinically significant in a risk adjustment payment model to achieve accurate and timely reimbursement and populate statistical databases. Queries physicians for clarification on documentation. Performs duties within approved practices, exercising independent judgment within pre-determined guidelines.

Minimum Job Requirements:

Work Experience:

Two years of outpatient coding experience required; experience with Hierarchical Condition Coding and Auditing preferred.

License/Registration/Certification: 

Certified Professional Coder (CPC) or Certified Coding Specialist- Physician based (CCS-P) required.

Certified Risk Adjustment Coder (CRC) required.

Education and Training: 

High School diploma or equivalent required.

Completion of coding program of study preferred.

Skills:

1. Knowledge of Health Information Systems practices, procedures, and guidelines.
2. Ability to analyze and solve problems.
3. Ability to seek out new methods and processes to improve services.
4. Ability to utilize verbal and written communication skills effectively.
5. Knowledge of the CPT® coding system and familiarity with the ICD-10-CM and HCPCS Level II
6. Knowledge of Centers for CMS-HCC risk adjustment model and methodologies