Clinical Operations Risk Adjustment Coder

Description:
• Review of medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog, larger chart page counts
• Work population of clinical pends, with goal to clear within 72 hours
• Updating and maintaining training course material for medical record abstraction and data entry (HEDIS, RISK, IVA)
• Reviewing training test scores and sending feedback if necessary
• Assigning and overreading disciplinary charts- (this is a chart move back) all projects
• Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs)
• Maintaining an accuracy score of 95% on all work submitted (all projects)
• Ability to adapt to changing priorities in managing a wide range of projects.
• Must be able to work independently and in a team environment
• Remote mentoring/ coaching (for all projects) in a group or 1:1 session with staff and leadership
• Client trainings (Reveleer technology, if needed)
• Over read challenges for all projects (reviewing abstractor/coder OR1 feedback challenges)
• Oversite and coordination of IVA documentation audits: ENR/RXC/ATT/DOB/GEN- Assist in training and successful adoption of Natural Language Processing/” Bot” -assisted coding reviews and relating tools/reporting
• Reviewing reports for workload assignments, looking at inventory by project to make sure sufficient headcount are assigned per workload (all projects)
• Multi time zone coverage/ shift coverage- evening/ weekends/holidays
• Managing and addressing questions and clarifications that coders submit to a designated online communication forum and “Q&A” email mailbox while reviewing charts
• Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
• Stay up to date with Risk/IVA protocols (coding clinics, coding guidelines)
• Maintain ongoing communication with Clinical Management team regarding coding workload, turnaround time expectations and deliverables
• Additional duties as necessary to meet the obligations to our clients

Requirements: • Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS) through AAPC and/or AHIMA. • Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC) • Additional experience in facility (OPPS/IPPS) coding experience is preferred • Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred • Ability to work independently in a fast-paced remote environment with minimal supervision and guidance • Ability to interact with management and remote coding personnel • Possess strong organizational skills and attention to detail • Ability to adapt to changing priorities while managing a wide range of projects • Adaptive and flexible to new ideas and change • Advanced knowledge of medical terminology, anatomy and pharmacology • Advanced skills utilizing official coding resources for research and problem solving • Advanced skills and knowledge of computers, use of required software to perform job functions • Excellent written and communication skills and the ability to explain complex information

Benefits:

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