This role focuses on the Risk Adjustment process supporting the documentation of acuity diagnoses for the Managed Care patient population and submission of records to Medicare Advantage payers under established capitated contracts. The position assists with medical record reviews for HCC diagnoses, proper usage of coding guidelines (ICD-10-CM, CPT, HCPCS), federal and Medicare Advantage payer regulations, and clinical validation of supporting documentation.
Responsibilities include maintaining compliance with coding guidelines, providing queries or guidance to physicians and clinical staff to resolve documentation issues, accurately abstracting diagnosis codes from patient records, selecting correct ICD-10-CM, CPT, and HCPCS codes, assessing notes for completion or deficiencies, performing audits for accuracy and EMR data entry, reviewing audit findings and payer denial reports for provider education, and completing electronic forms required for acuity diagnosis code submission.
The role requires tact, courtesy, adherence to customer service expectations in-person and virtually, participation in managed care projects including marketing and Medicare open enrollment, adherence to confidentiality and HIPAA requirements, and supporting team efforts to meet timelines and goals.
Maintain clinical competencies as per company policy. Uphold customer service standards in all communications. Apply official coding guidelines and coding principles. Utilize nursing and coding knowledge to perform review and validation of diagnosis codes. Communicate effectively with providers and staff to resolve documentation issues. Adhere strictly to HIPAA and confidentiality protocols. Meet deadlines and departmental goals consistently.
Location
San Antonio, Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
6 months ago