Risk Adjustment Coder - Medical Assistant

The HCC Professional Coder is responsible for:

• Review clinical documentation and assign accurate diagnosis codes according to CMS guidelines
• Verify the appropriateness of the ICD-10 code to include required supporting documentation and treatment plans
• Review medical documents such as progress notes, surgical reports, medical visits and diagnosis report in order to create educational strategies to ensure correct diagnosis code assignment by the provider
• Review medical records and billing history to determine if specific disease conditions were correctly billed and documented.
• Document detailed chart audit findings including all coding and documentation errors as well as any potential HCC opportunities.
• Improve coding accuracy by performing independent audits of physician records.
• Assist in developing strategic initiatives and training material tools related to HCC score improvement and accuracy for physician group
• Provide training to provider groups related to HCC documentation and coding
• Serves as a subject matter expert on MRA coding
• Perform other assigned duties/special projects on an as-needed basis.

Requirements, Skills and Abilities:

• Requires knowledge in Medicare Risk Adjustment (MRA) HCC coding documentation guidelines, rules and regulations
• Requires technical expertise in ICD-10-CM
• Prefer 2 years of HCC coding experience or Medical Assistant experience
• Can appropriately use coding principles to code to the highest specificity
• Proven success in building relationships and establishing credibility with providers and other clinical staff
• Strong skills in medical record audit and review
• Understanding of healthcare data systems
• Strong proficiency with MS Word and Excel
• Excellent problem-solving abilities along with written and verbal communication skills
• Strong collaboration and relationship building skills/Strong Team Player
• Ability to travel (day trips)

Minimum Education:

A High School Diploma or Equivalent