Risk Adjustment Coding Specialist II
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AI Summary
Job Description Summary
To scrub patient charts prior to appts to surface chronic conditions for providers review
How will you make an impact & Requirements
Perform prospective medical record reviews for clinical indicators supportive of an underlying diagnosis to be presented to a clinician for review during a subsequent face-to-face encounter.
Review the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission to validate completeness and accuracy of provider selected ICD-10-CM codes.
Collaborate with healthcare providers and other stakeholders to clarify documentation and ensure accurate coding and reporting of diagnoses.
Stay updated on changes to Medicare guidelines, coding regulations, and reimbursement methodologies to ensure compliance and accuracy in coding practices.
Participate in coding education and training initiatives for staff to promote consistent and accurate coding practices across the organization.
Stays current on applicable coding and documentation guideline changes and rules.
This role is expected to maintain a consistent accuracy rate of 95% or higher and able to meet productivity standards established by leadership.
Perform other job-related duties as assigned by leadership.
Pre-visit risk adjustment chart review for HCC's.
Required certification: CPC-A, CPC or CRC
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