Risk Adjustment Coder

What You’ll Do

Position Summary

The Risk Adjustment Coder willbe responsible forcoordinating/supporting Prospective, retrospective, and concurrent chart reviews using knowledge of Hierarchical Condition Categories (HCC) risk adjustment coding to translate, input, extract andvalidatemedical record data. The Risk Adjustment Coder will serve as an important part of the care team to improve documentation and codingaccuracy, andassistthe primary care team to deliver high quality preventive care to patients

Responsibilities

• Review all available patient medical records: Medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, dischargesummariesand any other available medical records.Determinewhether the diagnosis codes are supported by the documentation and are within the guidelines for coding and reporting (M.E.A.T). 

• Implement a pre-visit andpost visitaudit process withassignedprovider that accurately captures all documentation and coding with the greatest level of specificity. 

• Engage physicians and office staff to build andmaintaina good working relationship. 

• Ensure frequent touchpoints with your assigned providers and schedule meetings to discuss chart review. 

• Assistin obtaining medical records from internal and external providers to ensureaccuratedocumentation and to support audits requested by Health Plans. 

• Ensure compliance with all applicable Federal, State and/or County laws and regulations related to coding and documentation guidelines for Risk Adjustment. 

• Educate physicians and supporting office staff on proper billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation. 

• Demonstrate the ability to quicklyidentifymissing documentation and coding opportunities; incorrect coding and compliance trends; to analyze and investigate suspected problems with resolve; and toforwardproblems to the attention of your manager. 

• Must visit Providers onsite at their Practice toprovidereducation and feedback based on chart reviews. 

• Coderis responsible formeeting daily productiongoaland qualitygoalof averaging 95% accuracy rate on a consistent basis. 

• Must have skill set for outpatient primary care coding and medical record reviews.  

• Suggest and educate providers on correct coding CPT/HCPCS Level II/ICD 10 CM/Modifiers 

• Must have knowledge on HEDIS Codes and NCQA guidelines. 

• Other duties as assigned. 

What You’ll Bring

Knowledge, Skills, and Abilities

• ICD-10 coding: 3+years (Required) 

• Medicare risk adjustment coding: 3+years (Required) 

• Prospective and concurrent Risk adjustment retrospective review: 2+years (Required) 

• Provider education – 1+year experience (Required) 

• CPT and E&M coding: 1+year (Required) 

• Outpatient Primary Carecoding :1+ yearexperience (Required) 

• Elation EMR (Preferred) 

• CPC /CPMA/ CRC/ CCS-P/ CCS/ RHIA or RHIT certification (Required) 

Education, Experience, Licensure, or Certification Requirements

• High School orAssociate’sDegreeRequired

• Clinicaleducation (RN, LVN, LPN, Foreign Medical Graduate, Pharmacist) preferred

Suvida Healthcare provides equal employment opportunities to all Team Members and applicants for employment and prohibits discrimination and harassment of any type with regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Who We Are

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors.

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences, shared interests, and perspectives enh