Risk Adjustment Coder

POSITION SUMMARY

The Risk Adjustment Coding Specialist is responsible for Risk Adjustment HCC coding management and training both internally and externally to ensure that physicians, office staff and health plan representatives are working together effectively to achieve goals.

RESPONSIBILITIES-DUTIES

• Review medical record information to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Audit provider documentation of CPT, ICD-9 and ICD-10 codes to ensure adherence with coding and CMS Risk Adjustment guidelines
• Evaluate HCC auditing processes and provide analyses and recommendations to improve overall provider documentation and coding
• Responsible for ongoing provider education on HCC
• Support and participate in process and quality improvement initiatives
• Meet productivity and quality standards
• Review Comprehensive Annual Wellness Examination (CAPE) forms
• Performs other duties, as required

EDUCATION & EXPERIENCE REQUIREMENTS

• Bilingual proficiency in Korean preferred but not required
• Minimum 2 years HCC coding experience required
• Certified Medical Coder with either CPC or CCS
• Knowledge of Medicare managed care
• Cultivate positive professional and interpersonal relationships with providers and IPA
• Excellent verbal and written communication skills
• Effective organizational skills
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
• Ability to work both independently and as part of a team
• Must be able to achieve and maintain an accuracy standard of 95% and better
• Knowledge of Outlook, Word, Excel and PowerPoint
• EMR experience
• Must possess a reliable vehicle and clean and unrestricted CA driver’s license
• Must be able to travel

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On: Full employer-paid HMO and the option for a flexible PPO plan.
• Wellness Made Affordable: Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending: FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance: Generous PTO, 40 hours of sick pay, and 13 paid holidays to enjoy life outside of work.
• Career Development: Tuition reimbursement to support your education and growth.
• Team Fun: Paid company outings and lunches because we work hard, but we also know how to have fun!

Join AMM and experience a workplace where your health, growth, and happiness comes first!