Job Summary: The Coder 1 � Risk Adjustment is responsible for concurrent, prospective, and retrospective clinical documentation review as it pertains to Risk Adjustment Data Validation (RADV) timelines, with an emphasis on completeness and accuracy of provider documentation related to severity of illness and supporting clinical care plan(s) for the validation of Hierarchical Condition Category (HCC) diagnoses. Initiates communication, verbal and written, with providers to facilitate clarification of need for greater specificity, clinical support, and/or completeness of the progress notes. Provides compliant education related to documentation integrity, completeness, and consistency. Keeps providers up to date on CMS, ICD-10-CM, AHA Coding, health plan etc. guidelines as it pertains to Risk Adjustment for the purpose of, documentation trends and opportunities for improvement related to documentation integrity. Performs other duties as needed.
Education and Experience: Bachelor's degree in Health Information Management or other clinical/healthcare degree preferred; however, an equivalent combination of education and experience that provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements. 2+ years overall combined clinical/medical experience with at least 1+ year of Risk Adjustment coding specific experience or Clinical Documentation Improvement/Specialist equivalent.
Knowledge and Skills: Comprehensive understanding of the contents of a typical electronic medical record, medical terminology, abbreviations, ICD-10-CM coding conventions. Expertise in CMS Risk Adjustment Data Validation (RADV) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-10, CPT, and HCC coding preferred. Able to keyboard 40 wpm. Able to read; write legibly; speak in English with professional quality; use computer, printer and software programs necessary to the position; operate/troubleshoot basic office equipment require for the position. Able to relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following or enforcing policies; work calmly and respond courteously when under pressure; collaborate; and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; work independently with minimal supervision; performs basic math functions; manage multiple assignments effectively; work well under pressure; problem solve; organize and prioritize workload; recall information with accuracy; pay close attention to detail. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, medical records, and written documents necessary to position.
Licensures and Certifications: Certified Risk Adjustment Coder (CRC) required; Certified Clinical Documentation Specialist (CCDS) preferred. An equivalent combination of Risk Adjustment Coding work experience and other relevant American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification may be substituted for the stated certification requirements.
