[Hiring] Remote Risk Adjustment Medical Coder @Guidehouse

Role Description

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.

• 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.
• Achieves and maintains 95% accuracy in coding while maintaining the expected level of productivity.
• 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.
• 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.
• Notify administrative staff in the event they cannot meet the twenty-four hour turnaround standard.
• Check the Guidehouse email system at least every two hours during coding session.
• Maintain current professional credentials while working for Guidehouse.
• Become familiar with the Guidehouse coding website and use the information contained in the website as a daily tool.
• Maintain HIPAA compliant workstations.
• Review and adhere to the coding division policy and procedure manual content.
• Work well with other members of the facilities coding and billing team to ensure maximum efficiency and reimbursement for properly documented services.
• Communicate problems or coding principle discrepancies to their supervisor immediately.

Qualifications

• 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

Requirements

• 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

Benefits

• 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