Job description

TITLE

RISK ADJUSTMENT CODER I

POSITION SUMMARY

The Risk Adjustment Coding Specialist is responsible for Risk Adjustment HCC coding management and training both internally and externally to ensure that physicians, office staff and health plan representatives are working together effectively to achieve goals.

RESPONSIBILITIES-DUTIES

• Review medical record information to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Audit provider documentation of CPT, ICD-9 and ICD-10 codes to ensure adherence with coding and CMS Risk Adjustment guidelines
• Evaluate HCC auditing processes and provide analyses and recommendations to improve overall provider documentation and coding
• Responsible for ongoing provider education on HCC
• Support and participate in process and quality improvement initiatives
• Meet productivity and quality standards
• Review Comprehensive Annual Wellness Examination (CAPE) forms
• Performs other duties, as required

EDUCATION & EXPERIENCE REQUIREMENTS

• Bilingual proficiency in Korean preferred but not required
• Minimum 2 years HCC coding experience required
• Certified Medical Coder with either CPC or CCS
• Knowledge of Medicare managed care
• Cultivate positive professional and interpersonal relationships with providers and IPA
• Excellent verbal and written communication skills
• Effective organizational skills
• Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information
• Ability to work both independently and as part of a team
• Must be able to achieve and maintain an accuracy standard of 95% and better
• Knowledge of Outlook, Word, Excel and PowerPoint
• EMR experience
• Must possess a reliable vehicle and clean and unrestricted CA driver’s license
• Must be able to travel

Job Type: Full-time

Pay: $23.00 - $29.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Supplemental pay types:

• Bonus pay

Ability to commute/relocate:

• Buena Park, CA 90621: Reliably commute or planning to relocate before starting work (Required)

Experience:

• HCC Coding: 2 years (Preferred)
• Certified medical coder with either CPC or CCS: 1 year (Preferred)

Work Location: In person

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