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What You'll Do

The Coder, Risk Adjustment Coding is responsible for supporting the Strive operational and clinical team and partner Nephrologists by reviewing risk adjustment visits for appropriate clinical documentation support. This role is responsible for supporting the growth and improvement of Strive's risk adjustment capabilities. The coder will ensure technical aspects of diagnostic and procedure coding follow CMS, NCQA, third party payers and other regulatory agencies. They will review assigned provider's documentation and coding from end to end, including proper application of ICD-10 codes, CPT and CPT II codes. The coder shall educate assigned providers on CMS, AMA and Strive documentation and ICD-10-CM coding guidelines, as necessary. This role will perform provider queries and addendum requests based on CMA, AMA documentation and coding guidelines. This individual will assist in special coding audits and coding projects as necessary and provide ongoing feedback to the clinical management team regarding coding and documentation trends to ensure accurate coding and documentation to improve overall health outcomes for patients and continuity of care. This role will report to the Manager, Risk Adjustment.

The Day to Day

• Delivers value to Strive and its beneficiaries enrolled in Risk Adjusted government programs (MA, ACO, ACA, CKCC), using skills including but not limited to: HCC (Hierarchical Condition Category) Coding, medical coding, clinical terminology and anatomy/physiology, CMS coding guidelines, RADV Audits, and review of CPT and CPT II codes as applicable.
• Works closely with physicians, team members, quality, and compliance partners at enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
• Supports all Strive risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories.
• Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
• Performs HCC coding on projects for MA, ACA, and ESRD. Ability to quickly flex between coding projects, including retro and prospective, with different MA, ESRD, and ACA HCC Models.
• Works independently in various coding applications and electronic medical record systems to support departmental goals.
• Shall consistently meet coding productivity and 95% accuracy and any additional requirements as set forth by the Coding Manager.

Minimum Qualifications

• Active, approved CRC (Certified Risk Adjustment Coder) or CPC (Certified Professional Coder) License. From AAPC or AHIMA.
• 5+ years combined of related education, coding/auditing experience, or certification.
• Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency <60 ms.
• Ability to travel and be onsite to meet business needs.

Preferred Qualifications

• 5+ year's experience using ICD-10-CM, 2+years' experience with risk adjustment coding and training geared toward physicians.
• Expert in coding and documentation guidelines, knows how to develop strong relationships with clinicians, and is an effective, strong communicator.
• Successful candidates will also have presentation experience in the following areas: ICD-10-CM, CPT and HCPCS.
• Extensive knowledge of documentation and coding guidelines established by the Center for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) for assignment of diagnostic and procedural codes.
• Knowledge of Federal laws and regulations, including NCDs and LCDs affecting risk adjustment documentation and coding compliance.
• MS Office Suite, Electronic Medical Records, Encoder, and other software programs and internet-based applications.

About You

• Use a customer focused approach in dealing with conflict and resolution of problems.
• Strong clinical assessment and critical thinking skills.
• Excellent verbal and written communication skills.
• Ability to work in a remote team environment while also being a strong individual contributor.
• Flexibility and strong organizational skills needed.

Hourly Base Range: $27.88 - $32.21