Remote Risk Adjustment Coder

Summary

The job is a full-time remote position as a HCC Risk Adjustment Coder (Clinical Operations Specialist) at Reveleer, a healthcare data and analytics company. The role involves reviewing medical records, maintaining accuracy scores, managing projects, and providing coaching/feedback to coders among other duties.

Requirements

• Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS) through AAPC and/or AHIMA
• Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC)

Responsibilities

• Review of medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog, larger chart page counts
• Work population of clinical pends, with goal to clear within 72 hours
• Updating and maintaining training course material for medical record abstraction and data entry (HEDIS, RISK, IVA)
• Reviewing training test scores and sending feedback if necessary
• Assigning and overreading disciplinary charts- (this is a chart move back) all projects
• Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs)
• Maintaining an accuracy score of 95% on all work submitted (all projects)
• Ability to adapt to changing priorities in managing a wide range of projects
• Remote mentoring/ coaching (for all projects) in a group or 1:1 session with staff and leadership
• Client trainings (Reveleer technology, if needed)
• Over read challenges for all projects (reviewing abstractor/coder OR1 feedback challenges)
• Oversite and coordination of IVA documentation audits: ENR/RXC/ATT/DOB/GEN
• Assist in training and successful adoption of Natural Language Processing/” Bot” -assisted coding reviews and relating tools/reporting
• Reviewing reports for workload assignments, looking at inventory by project to make sure sufficient headcount are assigned per workload (all projects) multi time zone coverage/ shift coverage- evening/ weekends/holidays
• Managing and addressing questions and clarifications that coders submit to a designated online communication forum and “Q&A” email mailbox while reviewing charts
• Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s)
• Stay up to date with Risk/IVA protocols (coding clinics, coding guidelines)
• Maintain ongoing communication with Clinical Management team regarding coding workload, turnaround time expectations and deliverables
• Additional duties as necessary to meet the obligations to our clients

Preferred Qualifications

• Additional experience in facility (OPPS/IPPS) coding experience is preferred
• Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred

Benefits

• Competitive pay
• Medical, Dental and Vision benefits including HSA/FSA
• 401k with Employer Match
• 100% paid short term and long-term disability insurance
• PTO plan and 10 paid company holidays