Risk Adjustment Medical Coder / DRG CPT Validator

Responsibilities include but are not limited to the following:

• Assign appropriate ICD 10 CM codes mapping to risk adjustment models for Medicare Advantage and ACA Commercial Projects.
• Assign Flag events and CDI for documentation discrepancies.
• Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines.
• Comply with HIPAA laws and regulations.
• Maintain quality 97 percent and production standards.
• Remain current on diagnosis and coding guidelines and risk adjustment reimbursement reporting requirements.

Qualifications

• With at least 6 months medical coding experience.
• HCC Risk Adjustment Experience.
• Experience with In Patient, Out Patient, or Facility Coding.
• Well versed in CPT coding including modifiers.
• Must be College Graduate with at least 6 months of BPO experience.
• Active coding certification under AAPC or AHIMA.
• Certified Risk Adjustment Coding Certification (CRC) preferred.
• Able to code using ICD 10 CM physical codebook or coding software.
• Strong clinical knowledge related to chronic illness diagnosis, treatment, and management.
• Computer proficiency (MS Office and Internet).
• Must be able to work onsite on graveyard shift.