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Crc Risk Adjustment Coder Jobs in North Carolina

Wilmington Health PLLC

Actuary

Wilmington, NC · On-site

Analyze risk adjustment data, including HCC/RAF trends, coding patterns, demographic factors, disease burden, and documentation opportunities. * Develop reports, dashboards, and executive summaries ...

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Crc Risk Adjustment Coder information

What is the difference between Crc Risk Adjustment Coder vs Medical Coder?

AspectCrc Risk Adjustment CoderMedical Coder
CertificationsCPMA, CPC, or RHIT/RHIA often preferredCPC, CCS, or CPC-H
Work EnvironmentHealthcare facilities, insurance companies, risk adjustment teamsHospitals, clinics, physician offices
Industry UsageRisk adjustment, Medicare Advantage, health plansMedical billing, coding, documentation

The Crc Risk Adjustment Coder specializes in coding for risk adjustment programs, focusing on accurate documentation for insurance and Medicare plans. Medical Coders handle a broader range of medical records and billing tasks across various healthcare settings. While both roles require coding certifications, Crc Risk Adjustment Coders focus more on risk and reimbursement accuracy within insurance programs.

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Crc Risk Adjustment Coder jobs near you

Risk Adjustment Coding Specialist II

Millennium Physician Group

Concord, NC • On-site

$22 - $33/hr

Full-time

Posted 14 days ago

Millennium Physician Group rating

6.3

Company rating: 6.3 out of 10

Based on 63 frontline employees who took The Breakroom Quiz

671st of 887 rated healthcare providers

Job description

Job Description Summary

Under the direction of Burden of Illness department leadership, the Risk Adjustment Coding Specialist is responsible for various aspects of decision-making and coding reviews to facilitate, obtain, validate, and reconcile appropriate provider documentation for clinical conditions that accurately reflect the severity of illness and complexity of patient care.

How will you make an impact & Requirements

Responsibilities

  • Perform prospective medical record reviews forclinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
  • Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
  • Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
  • Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
  • Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
  • Stays current on applicable coding and documentation guideline changes and rules.
  • This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
  • Abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation not initially assigned to the encounter claim following ICD-10-CM Official Guidelines for Coding and Reporting.
  • Conduct retrospective audits of medical recordsto validate the accuracy and completeness of diagnosis coding and claim submission, identifying and resolving any discrepancies or areas for improvement.
  • Perform comprehensive reviews of provider actions within the Value Based Alert Tool (VBAT) to identify outliers and areas of opportunity.
  • Analyze MRA data to identify patterns andwhen requestedassist in the development of interventions at the provider andregionlevel.
  • Keeps department leadership appraised of project activities through regular written and oral status reports. Proactively identifies risks that may hinder project success.

Compensation:

$22.00

to

$33.00

What Millennium Physician Group employees say

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