The Coder of Risk Adjustment will be responsible for accurate coding and documentation which is imperative to support proper reimbursement from Medicare while ensuring organizational compliance. The Coder will perform production coding and coding auditing as well as medical record abstraction in support of the Healthcare Effectiveness Data and Information Set (HEDIS) data collection. The ideal candidate will be well grounded in sound medical coding practices, with experience working in the CMS Medicare Advantage and/or HHS Commercial risk adjustment model. Knowledge of HEDIS data collection is required.
· High school education or GED. Associate's degree preferred.
· Coding certification (CCS or CPC through AHIMA/AAPC)
· ICD-10 coding proficiency
· 3-5 years’ experience in CMS HCC risk adjustment coding
· 2 years’ experience in a managed care setting
· RHIT and CRC certification preferred.
- Ability to effectively communicate in English, both verbally and in writing.
· Proficient in Microsoft Office Suite – Word, Excel and Access
· Excellent written and oral communication skills
· Attention to the detail.
· Billing experience is a plus.
· Comfortable working in a department with set productivity and coding accuracy standards
· Experience with NCQA HEDIS programs preferred.
· Experience working in health care and health insurance industry. Knowledge of HEDIS data collection is preferred.