Medical Coder with Risk Adjustment Coding

Full job description
Role: Medical Coder with Risk Adjustment Coding
Key Responsibilities:
Accurately assign diagnosis codes following the Official ICD-10-CM Guidelines for Coding and Reporting. This includes coding for conditions relevant to the Center for Medicare & Medicaid Services’ Hierarchical Condition Categories (CMS-HCC), covering the year(s) of service under review.
Conduct thorough chart reviews by leveraging computer-assisted coding tools to assess, interpret, and apply appropriate coding principles. This ensures valid diagnosis codes are supported by documented evidence in the medical record, all done on the same day of service.
Demonstrate a comprehensive understanding of CMS-HCC guidelines to ensure the medical records align with standards, including but not limited to signature requirements, medical encounter types, and places of service.
Exhibit advanced knowledge of medical terminology, anatomy, and physiology to accurately assign diagnosis codes and capture supporting information from the medical record.
Effectively manage the quality and productivity of individual work, ensuring goals are met or exceeded.
Perform necessary administrative duties as directed by the Team Lead/Operations Lead/Quality Lead.
Consult with the Team Lead/Operations Manager or Subject Matter Expert (SME) in Coding as necessary to ensure accuracy and compliance.
Job Requirements and Qualifications
License/Certification
Must hold and maintain an active certification as a Certified Professional Coder (CPC) and/or Certified Risk Adjustment Coder (CRC) through the American Academy of Professional Coders (AAPC).
Alternatively, a Certified Coding Specialist (CCS) and/or Certified Coding Specialist – Physician-based (CCS-P) through the American Health Information Management Association (AHIMA) is acceptable.
Education
Associate Degree or equivalent HCC coding experience.
Skills
Proficient in computer use, including MS Windows, MS Office, and internet-based tools.
Proficient in the use of official ICD-10-CM coding books or encoder software, corresponding to the dates of service being reviewed.
Demonstrates the ability to assign diagnosis codes accurately following the official guidelines and section/chapter level instructions.
Ability to apply ICD-10-CM outpatient diagnosis coding guidelines.
Preferred Skills/Experience
Knowledge of Hierarchical Condition Code (HCC) concepts.
Familiarity with HIPAA regulations, ensuring the protection of privacy, security, and confidentiality of medical records.
Understanding of the AMA format and CMS HCC Risk Adjustment coding, along with validation requirements.
EMR/EHR experience preferred.
Additional Details:
4-Month Non-Renewable Contract
Shifts: 1 PM-10 PM and 3 PM-12 MN
Two Weeks Full Onsite Training
Regular Work: Twice a Week RTO