Remote Risk Adjustment Medical Coder

Job Family : General Coding Travel Required : None Clearance Required : None What You Will Do : The Remote Risk Adjustment Coder must be proficient in ICD10CM Risk Adjustment coding as well as Evaluation & Management & Annual Wellness Visit Coding. Will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-10 Diagnosis codes, along with CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research as required, and regulatory compliance. Under the direction of the coding manager/supervisor—the coder will accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. The coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines. This position is full-time and 100% remote. Responsibilities: Demonstrates the ability to perform quality coding of medical records. Maintains a working knowledge of ICD-10 and CPT coding principles, governmental regulations, official coding guidelines, and third-party requirements regarding documentation and billing. Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes. When services/diagnoses are not documented appropriately, they seek to attain proper documentation in a timely manner according to facility standards. Achieves and maintains 95% accuracy in coding while maintaining the expected level of productivity. Accuracy will be monitored during monthly reviews either within the facility. Ability to maintain average productivity standards as follows Works the review queue daily to ensure all charts that are placed in the review queue are worked and any corrections are communicated to the facility if necessary. Charts that require re-bills are corrected and communicated to the facility daily for the re-bill process. See re-bill policy in facility guidelines. Coder downtime must be reported immediately to the administrative staff to ensure turnaround is met. Responsible for working directly with the IQC staff to ensure quality standards are being met for each facility. Provides accurate answers to physician’s/hospitals coding and/or billing questions within eight hours of request. Responsible for coding or pending every chart placed in their queue within 24 hours. It is the responsibility of the coder to notify administrative staff in the event they cannot meet the twenty-four hour turn around standard. Coders are responsible for checking the Guidehouse email system at least every two hours during coding session. Coders must maintain their current professional credentials while working for Guidehouse. Coders are responsible for becoming familiar with the Guidehouse coding website and using the information contained in the website as a daily tool to correctly code and abstract for each facility. Coders are responsible for maintaining HIPAA compliant workstations (reference HIPAA workstation policy) It is the responsibility of each coder to review and adhere to the coding division policy and procedure manual content. Works well with other members of the facilities coding and billing team to insure maximum efficiency and reimbursement for properly documented services. Communicates problems or coding principle discrepancies to their supervisor immediately. What You Will Need : High School Diploma or equivalent 3+ years HCC Risk Adjustment Coding. CPC or CRC certification from AAPC EMR experience Must maintain credential throughout employment Strong working knowledge & experience with Federal & State Coding regulations and Guidelines What Would Be Nice To Have : Ability to work independently, multi-task well and interface with all levels of personnel as well as clients Excellent verbal, written and interpersonal communication skills Basic knowledge of Excel, Word and PowerPoint High level of accuracy Previsit & Retrospective Risk Adjustment planning methodology experience Experience with CMS HCCESRD PACE, CMS HCC-RX, CDPS, CDPS-RX &/or HHS HCC CMA or LPN certification The annual salary range for this position is $44,000.00-$74,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. What We Offer : Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: Medical, Rx, Dental & Vision Insurance Personal and Family Sick Time & Company Paid Holidays Position may be eligible for a discretionary variable incentive bonus Parental Leave 401(k) Retirement Plan Basic Life & Supplemental Life Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts Short-Term & Long-Term Disability Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community Outreach Emergency Back-Up Childcare Program About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at [email protected] . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or [email protected] . Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact [email protected] . Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.