Risk Adjustment Coder (Hybrid)
HybridSan Antonio, Texas, United States
Job Summary
Validate and abstract diagnosis codes from patient medical records to ensure reported ICD-10 codes are supported by documentation. Select correct ICD-10-CM, CPT, and HCPCS codes based on clinical validation, focusing on accurate capture of all supported HCC diagnosis codes. Provide queries or technical guidance to physicians and staff to resolve documentation errors, ambiguous notes, or codes that do not conform to approved guidelines. Perform reviews of Risk Adjustment audits for accuracy and data entry into the EMR, while assessing qualifying notes for deficiencies and communicating with providers to address them. Review payer denial reports to identify areas for provider education and maintain compliance with coding guidelines and HIPAA requirements.
Required Qualifications
- Minimum high school education or equivalent
- Active Coding Certification by AHIMA (RHIA, RHIT, CCS, CCS-P or CCA) or AAPC (CPC, CRC)
- Graduation from an approved practical nursing program and state-licensed practical nurse
- CPR with AED certification
- 3+ years' experience in working with the Risk Adjustment (HCC) process
- Knowledge of ICD-10-CM, CPT, and HCPCS coding systems, guidelines, and rules
- Knowledge of billing regulations, Managed Care insurance coverage limitations and protocols
- Knowledge of medical terminology, medical procedures, human anatomy, and physiology
- Skilled in use of computer/EMR systems
- Knowledge of Word processing software, spreadsheet software, Internet, and database software
- Manual dexterity
- Ability to sit
- Ability to stand
- Ability to stoop
- Ability to reach
- Ability to kneel
- Ability to crouch
- Ability to bend
- Ability to walk
- Ability to lift up to 40 lbs. without assistance
- Close vision and ability to adjust focus
- Ability to work efficiently under pressure
Desired Qualifications
- Graduation from an approved practical nursing program and state-licensed practical nurse
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.