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Risk Adjustment Coder Professional Billing II

Prisma Health

Conducts prospective reviews to abstract Hierarchical Condition Category (HCC) codes for calendar-year reporting. Communicates with providers via Epic and in person regarding outstanding HCC capture opportunities and performs retrospective reviews to ensure documentation supports reporting prior to payer submission.

  • Conducts prospective chart reviews to identify HCC opportunities
  • Conducts retrospective chart reviews to confirm documentation supports reporting
  • Uses payer-specific software to assist in capturing HCCs
  • Communicates with providers about opportunities for improvement
  • Identifies suspect conditions that may support HCC reporting
  • Participates in education offerings and monthly meetings
  • Performs other duties as assigned
Requirements & Qualifications
  • High school diploma or equivalent required; post-high school diploma or associate degree preferred
  • Five years of professional fee coding experience
  • Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC)
  • Proficiency with office equipment, word processing, spreadsheets, and databases
  • Data entry and mathematical skills

Location

South Carolina, US

Employment Type

Full-time

Experience Level

Intermediate Level

Remote work allowed

Yes

Posted

1 month ago

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