The Value Based Coder II is an experienced professional within the Quality Management/Risk team, responsible for independently reviewing patient medical records to identify, assess, monitor, and review coding opportunities, with a growing emphasis on Hierarchical Condition Categories (HCC). This role focuses on developing and delivering provider education and contributing to process improvement initiatives. The Value Based Coder II acts as a valuable resource in identifying clinically appropriate risk-adjusting conditions and supporting provider documentation improvement.
- Independently review patient medical record information to identify, assess, monitor, and review network coding opportunities related to risk adjustment and HCC.
- Validate the accuracy and completeness of HCC documentation and coding.
- Analyze clinical documentation across the network to identify patterns, trends, and improvement opportunities related to HCC capture.
- Develop and deliver education materials and tools to help providers improve clinical documentation and HCC coding capture.
- Provide targeted provider 1:1 education on documentation best practices, HCC guidelines, and risk adjustment principles.
- Monitor and interpret evolving HCC coding guidelines, CMS regulations, and compliance trends within risk adjustment.
- Ensure adherence to federal and coding guidelines relating to HCC and risk adjustment.
- Safeguard medical records and preserve confidentiality of personal health information in compliance with policies including HIPAA.
- Participate in network performance improvement initiatives and collaborate with providers and staff to address documentation and coding gaps.
Requirements & Qualifications
- Minimum 2 years of experience in outpatient coding.
- Minimum 2 years focused on risk adjustment and HCC principles.
- Advanced knowledge of CPT and ICD-10 coding, especially HCC coding guidelines and risk adjustment models.
- Strong understanding of federal and state coding guidelines and sponsored programs.
- Proficiency in developing and delivering educational content.
- Effective interpersonal, communication, and presentation skills.
- Ability to manage multiple priorities and work independently.
- Computer literacy with medical information systems, records management software, and encoder software.
Preferred:
- 4+ years of outpatient coding experience.
- 3+ years of experience focused on risk adjustment and HCC principles.
Location
Houston, Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
3 weeks ago
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