Responsible for medical record retrieval and over-reads for audit project activities related to risk adjustment and revenue accuracy. Collaborates with cross-functional teams to support risk adjustment program efforts and ensure coding, documentation, and reporting accuracy.
Key responsibilities include:
- Monitoring audit project activities and performing outreach to physician groups and contracted vendors for chart procurement
- Researching and resolving non-retrievable chart case inventory
- Retrieving records through electronic and on-site methods
- Reviewing, interpreting, auditing, coding, and analyzing medical records, claims, and encounter information as it relates to HCC
- Reviewing vendor coding guidelines to ensure alignment with ICD guidelines, CMS rules and organizational policies
- Assisting in the development of risk adjustment documentation, coding tools, and resources
Requirements & Qualifications
- 3+ years of experience in the health industry, including medical record coding
- Preferably experience with HCC and/or risk adjustment coding
- Certified Professional Coder (CPC)
- Must hold or obtain Certified Risk Adjustment Coder (CRC) within one year of hire
- Preferred: CRC at time of application
- Preferred: Clinical certification (CNA, MA, or above) and/or associate or bachelor’s degree
- Proficient with ICD-10-CM, CPT, and HCPCS code sets
- Knowledge of billing/claims submission, HIPAA guidelines, medical terminology, anatomy, physiology, disease processes, and basic pharmacology
- Experience with electronic medical record (EMR) systems
- Strong analytical, communication, and organizational skills
- Proficiency with Microsoft Office applications
- Ability to work effectively in a fast-paced, cross-functional environment
Benefits & Perks
- Paid time off
- Paid holidays
- Community service and self-care days
- Medical, dental, vision, and pharmacy insurance
- 401(k) matching and non-contributory plan
- Life insurance
- Short- and long-term disability
- Education reimbursement
- Employee assistance plan (EAP)
- Adoption assistance program
- Paid family leave program
- Annual incentive bonus eligibility
Location
Idaho, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 week ago