Certified Risk Adjustment Coder

SUMMARY

The Certified Risk Adjustment Coder is responsible for accurately abstracting provider services into ICD-10 codes from medical documentation. This role adheres to the coding ethics of organizations such as the American Academy of Procedural Coders (AAPC), American Health Information Management Association (AHIMA), and the National Alliance of Medical Auditing Specialists (NAMAS), as well as payer guidelines. The coder conducts concurrent, prospective, and retrospective reviews of medical record documentation to ensure the accurate and complete capture of the clinical picture, severity of illness, and complexity of patients. Additional duties include provider communication and education to support the closure of both risk adjustment and quality care gaps, as well as providing ongoing feedback to physicians regarding coding guidelines and requirements.

ESSENTIAL JOB FUNCTIONS

• Perform coding quality audits of medical records to ensure ICD-10 codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS guidelines.
• Review provider documentation to identify clinical documentation gaps, and design, plan, and deliver education sessions to providers either individually or in group settings.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education on documentation supporting the most appropriate level of ICD-10 specificity.
• Assist with educational in-services for physicians, other providers, and clinic staff regarding accurate clinical documentation, best coding practice, and regulatory compliance related to billing.
• Ensure compliance with all applicable federal laws and regulations related to coding and documentation guidelines for healthcare billing.
• Perform pre-appointment chart reviews, coding audits, or other coding-related projects
• Provide real time coding consultation/review and evaluate documentation to improve coding practices
• Query providers for clarification on documentation inquiries
• Serve as a resource for providers regarding medical documentation inquiries
• Maintain knowledge of current coding guidelines, annual updates, and changes to ensure coding and billing compliance.
• Review and update coding policies and procedures as needed
• Perform other job duties as required by manager/supervisor

SUPERVISORY RESPONSIBILITIES

None

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent communication, interpersonal, and organizational skills
• Experience with Epic is required
• Strong critical thinking abilities
• Ability to adapt quickly to changes in policy, practice, and procedures
• Energetic and proactive, with the ability to work both independently and as part of a team

EDUCATION/EXPERIENCE and SKILLS:

Education:

• BS/BA Degree in Health Science or General Education is highly preferred; however, completion of a two-year degree is required.

Certifications:

• Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC), or equivalent coding certifications are required.
• Additional certifications in Clinical Documentation Improvement (CDI) or auditing (e.g., CCDS, CDEO, CPMA) are preferred.

Experience:

• 3 years of experience in risk adjustment coding.
• Experience in provider education, clinical documentation improvement (CDI), and chart audits.

CONDITION OF EMPLOYMENT:
Salinas Valley Health Clinics requires you to prove that you have received the COVID-19 vaccine or have a valid religious or medical reason not to be vaccinated.

The range displayed on this job posting reflects the target for new hire salaries for this position.