Risk Adjustment Coder

We are seeking a detail-oriented and experienced Risk Adjustment Coder to join our dynamic team. The ideal candidate will be responsible for ensuring the accuracy and completeness of clinical data used to support risk adjustment coding for our Medicare plan. You will work closely with healthcare providers and clinical teams to identify and mitigate documentation gaps, ultimately supporting our mission to provide exceptional care to our members.

· Responsibilities related to Risk adjustment processes

o- Conduct thorough reviews of medical records to ensure accurate coding and complete documentation for risk adjustment purposes.

- Apply ICD-10-CM and HCC coding guidelines to properly document diagnoses and procedures for Medicare beneficiaries.

- Collaborate with clinical staff to educate and improve documentation practices to support accurate risk adjustment coding.

- Identify opportunities for improvement in documentation and coding processes, and participate in quality improvement initiatives.

- Maintain current knowledge of risk adjustment methodologies, coding guidelines, and Medicare regulations.

- Generate coding reports and provide feedback to medical staff regarding documentation compliance.

- Participate in training sessions and continuous education to stay updated on industry changes.

· Other duties as assigned

Specific Knowledge, Skills, and Abilities:

· Ability to read and interpret documents, identify areas of coding gaps. Ability to speak effectively with physicians and employees of the agency.

· Ability to identify areas of over or under utilization and work with team and physician groups to develop processes to avoid

· Ability to work with team on development of processes for right-coding, appropriate utilization, and closing gaps in care