Risk Adjustment Coder

1000 NW 57th Court, Suite 400 Miami, FL 33126

At ClareMedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At ClareMedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to ClareMedica.

This position reports to the Manager of Risk Adjustment Coding. As a member of the Risk Adjustment team, the Outpatient Risk Coder works remotely in collaboration with hospitalists and hospital staff with opportunities for improved quality, risk adjustment coding performance. The Outpatient Risk Coder is a valuable resource in process improvement and identifying clinically appropriate risk adjusting conditions to capture. Must possess the ability to work independently with strong organizational, communication and interpersonal skills to support the management of multiple priorities, at multiple practice locations, with significant attention to detail for completion of both verbal and written external communications. 

DUTIES AND RESPONSIBILITIES:

• Ensure that the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted timeframe 
• Review outpatient medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to risk adjustment 
• Assess adequacy of documentation of claims and query outpatient provider claims to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding 
• Audit provider documentation ICD-9 and ICD-10 codes to ensure adherence with CMS Risk Adjustment guidelines 
• Participate in departmental and physician network performance improvement initiatives. 
• Safeguards medical records and preserves the confidentiality of personal health information through the observance of physician network policies pertinent to the release of medical record information, record retention, and HIPAA privacy and security. 
• Performs other duties as requested. 

Qualifications

QUALIFICATIONS/REQUIREMENTS

• Certified Professional Coder (CPC) or Certified Risk Coder (CRC).
• Associate degree in healthcare or equivalent work experience. 
• 2-3 years of experience in outpatient coding preferred.  
• Bilingual is a plus.
• Intermittent physical activity includes walking, standing, sitting, lifting up to 30 lbs. and pushing carts.
• Required to work at any facility and be responsible for own transportation.
• Will be scheduled based on operational needs.
• Computer literacy required.
• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.  
• Consistently demonstrate ability to take the initiative to make decisions/choices within scope without direct supervision.
• Demonstrate knowledge and understanding of all policies and procedures and ability to reference them from appropriate books and manuals.
• Comply with standards set by various governmental agencies.

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function. 

While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus.  Frequent travel is required, often up to several hours of driving per day.  Ability to travel to, attend, and conduct sales presentations.  Manual dexterity required to use desktop computer and peripherals.  Exposure to variable weather conditions is likely.

WORK ENVIRONMENT

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

The noise level in the work environment is usually moderate.

TRAVEL

Travel is primarily local during the business day, although some out-of-area and overnight travel may be expected.

SAFETY HAZARD OF THE JOB

Minimal Hazards