HCC/Risk Adjustment Coder

Job title: HCC/Risk Adjustment Coder
Location: 100% remote
Job duration: 3 months+
 
Pay Range: $27 to $29/hr. on W2
 
Schedule notes:
Monday-Friday: 8 AM – 5 PM EST. This position is 100% remote and candidates can be sourced from across the US as long as they’re able to support the EST schedule. Candidates must have a quiet and private working environment. Candidates must have a reliable, high-speed internet connection.
 
Job description:

• Responsible for coordination and implementation of daily processes related to IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis program.
• Responsible for liaising with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes, including but not limited to file reconciliation and appeals processes.
• Responsible for coordinating with Quality Management to effectively and compliantly execute daily RA program operations, as identified. Participates in coding reviews of medical documentation for RA programs, as needed.
• Responsible for communication and reporting of daily productivity and risks associated with IFP RADV audits and other RA programs, as needed, and collaborates with internal educational team to develop necessary curriculum to ensure compliance and program excellence.
• Contributes to Client IFP Coding Guideline updates and policy determinations, and liaises with Matrix Partners, as required, to develop and promote shared goals.
• The Quality Review and Audit Senior Analyst position recognizes experience in Risk Adjustment Data Validation audits (RADV), Risk Adjustment operations, Risk Adjustment medical record and diagnosis coding excellence, implementation of Quality Improvement processes, and the ability to communicate experience and knowledge to peers, colleagues, and Matrix Partners.

• High school diploma.
• 5+ years of Risk Adjustment experience, with certification by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) in one of the following certifications:
  • Certified Professional Coder (CPC)
  • Certified Coding Specialist for Providers (CCS-P)
  • Certified Coding Specialist for Hospitals (CCS-H)
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
• Flexible on less than 5 years of Risk Adjustment experience if candidate has HHS/ACA coding experience.
• Certified Risk Adjustment Coder (CRC) certification (within 12 months of hire).
• Experience with medical audits.
• Proficiency with ICD-10-CM coding and guidelines.
• Familiarity with CMS regulations and policies related to documentation and coding, both with inpatient and outpatient documentation.
• HCC coding experience preferred.
• Computer competency with Excel, MS Word, Adobe Acrobat.
• Must be detail oriented, self-motivated, and have excellent organization skills.
• Risk Adjustment/CMS knowledge helpful.
• Understanding of medical claims submissions helpful.