The Risk Adjustment Medical Coding Specialist is responsible for the timely review of charges submitted by Providers and assigning accurate coding of Services ICD-10 HCC, CPT and HCPCS codes to ensure to ensure proper billing and effective claim submission to the health plan.
This role will be supporting the Government business side of our Integrated Kidney Care Division. Responsibilities include the following:
o Review Provider notes to abstract, assign and enter valid ICD-10/HCC, CPT, and HCPCS codes into EHR Platform (EPIC)
o Perform medical chart reviews to identify and correct any missed or erroneous HCC codes according to HCC coding requirements
o Work with Providers to gain clarification or provide feedback to resolve discrepancies identified during the coding process.
o Enter charges into the practice management system (MEDfx)
o File electronic claims within 48-72 hours of entry
o Other duties as assigned.
What Skills Do you Bring to the Role?
- 5 years of medical coding experience with a minimum of 2 years as a Risk Adjustment Coder in a health plan
- Coding Certification required; CPC, CRC or CCSP.
- Knowledge of ICD-10, CPT, HCPCS and HCC models of coding guidelines
- Required knowledge and understanding of Medicare Advantage guidelines
- Knowledge of medical terminology, Anatomy and Physiology, pharmacology and Electronic Health Record (“EHR”) Systems
- Proficiency in MS Excel and Word
- Strong Analytical and problem solving skills along
- Proven ability to meet deadlines
- Solid Organizational skills and attention to detail
- Ability to maintain confidentiality of patient information
- Ability to work quickly, accurately and independently