RISK ADJUST CODER-RISK MANAGEMENT

Physician Office Kettering Full-Time First Shift

Job Overview:

The Certified Risk Adjustment Coder is responsible for reviewing the ambulatory records for the appropriate risk adjustment components.  The Risk Adjustment Coder will identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes.  The Risk Adjustment Coder will leverage the MEAT (Monitor, Evaluate, Assess, Treat) criteria for accurate documentation by providers.

When appropriate, the Risk Adjustment Coder will query providers to clarify the HCC codes placed, inquire on additional documentation to support the HCC code placed, or discuss overall opportunities within the record.

The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records.  The Risk Adjustment Coder will contribute to overarching educational efforts of the MSO regarding Risk Adjustment.  The Risk Adjustment Coder will offer summarized content, feedback from providers, key barriers or success efforts to executive leaders to assist in the overall risk adjustment of the population. 

The Risk Adjustment Coder will spend some in-person time with providers to foster a relationship and encourage dialogue with risk adjustment to improve overall outcomes. The Risk Adjustment Coder will develop a collegial relationship with the Clinical Documentation Specialist RN (CDS) to partner on the overarching risk adjustment of the population.

Job Responsibilities:

The Risk Adjustment Coder is responsible for coding and abstracting all outpatient patient records using ICD-10-CM and CPT/HCPCS coding rules, federal guideline and KMCN guidelines. Additionally, the Risk Adjustment Coder supports hospital’s accounts receivable goals through timely processing of records and physician record completion activities. Impacts delivery of quality patient care and enhanced clinical decision-making process. Supports clinical outcomes measurement and assessment process for service lines. Completes assigned duties and other related tasks. The list is not inclusive, Performs other duties as assigned.

Preferred Education:

Associate or Bachelor’s Degree in Health Information Management

Work Experience:

Minimum of one to two years coding/abstracting experience in Professional Fee services, Hospital or Medical office.

Required Certification:

• CRC (Certified Risk Adjustment Coder) required.

Certifications accepted below with arrangement for CRC exam will be considered.

AAPC (American Academy of Professional Coders)

• CPC (Certified Professional Coder).
• CEMC (Certified Evaluation and Management Coder)
• CANPC (Certified Anesthesia and Pain Management Coder)
• CCC (Certified Cardiology Coder)
• CCVTC (Certified Cardiovascular and Thoracic Surgery Coder
• CFPC (Certified Family Practice Coder)
• CGIC (Certified Gastroenterology Coder)
• CGSC (Certified General Surgery Coder)
• CHONC (Certified Hematology and Oncology Coder)
• CIRCC (Certified Interventional Radiology Cardiovascular Coder)
• COBGC (Certified Obstetrics Gynecology Coder)
• COSC (Certified Orthopedic Surgery Coder)
• CPEDC (Certified Pediatrics Coder)
• CUC (Certified Urology Coder)
•  
• AHIMA (American Health Information Management Association)

• RHIT (Registered Health Information Technician)
• RHIA (Registered Health Information Administrator)
• CCA (Certified Coding Associate)
• CCS (Certified Coding Specialist)
• CCS-P (Certified Coding Specialist-Physician-based)

NHA (National Healthcareer Association)

• CBCS (Certified Billing & Coding Specialist)

Preferred member of AHIMA and/or AAPC Professional Associations.

Skills:

Strong written and verbal communication skills. Proficient in data entry, personal computers, knowledge of medical terminology, anatomy and physiology and disease processes

Ability to work with interdisciplinary teams, providers and clinicians

Self-awareness with conflict or disagreement