Risk Adjustment Coder (Hybrid)
HybridSan Antonio, Texas, United States
San Antonio, Texas, United StatesHybridFull TimeAssociates Degree
Full TimeAssociates Degree
Job Summary
Conduct medical record reviews to validate and abstract diagnosis codes from provider documentation, ensuring accurate ICD-10-CM, CPT, and HCPCS selection for HCC diagnoses. Provide queries or technical guidance to physicians and clinical staff to resolve documentation errors, incomplete records, or ambiguous coding principles. Perform Risk Adjustment audits for accuracy, enter data into the EMR, and review payer denial reports to identify areas for provider education. Communicate with providers on note deficiencies to ensure processing within required timelines while adhering to HIPAA and Gonzaba Medical Group policies.
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, stand, stoop, reach, kneel, crouch, bend, 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
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