Medicare Risk Adjustment Coding Specialist

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Conducting coding audits before the release of payments.

• Executing post-payment coding evaluations related to overpayments.

• Dispatching coding education communications to relevant providers.

• Analyzing medical records, along with patient medical histories and physical examinations.

• Aiding in validation audits to assess the accuracy of medical record documentation.

• Interpreting medical documentation to ensure that coding accurately reflects HCC conditions.

• Creating tools and metrics aimed at enhancing coding and documentation precision.

• Delivering exceptional customer service to both internal and external clients.

• Elevating pertinent coding audit concerns to management.

• Engaging in and assisting with ad-hoc coding audits as required.

• Supporting ongoing initiatives to reduce organizational risk during RADV Audits.

• Finalizing assigned coding projects.

• Performing additional duties as necessary.

⛳️ Requirements

• High school diploma or equivalent.

• Two years of experience with complex claims processing and/or coding auditing within the health insurance sector or medical healthcare delivery system.

• Two years of experience in a managed healthcare environment related to claims and/or coding audits.

• Two years of experience with standard coding and reference materials used in claims settings, including CPT4, ICD10, HCPCS, and others.

• Two years of experience with CMS regulations concerning claims processing and coding, particularly for skilled nursing and other intricate claim processing rules and regulations.

• Two years of experience in coding/auditing claims for Medicare and Medicaid programs.

• Extensive HCC experience, including knowledge of HCC mapping and hierarchy.

• Coding certification is mandatory (CPC or CRC).

• Travel may be necessary.

🏝️ Benefits

• Affordable medical, dental, and vision insurance options.

• Generous paid time-off program along with paid holidays for full-time staff.

• 24/7/365 access to doctors through TeleDoc.

• Optional short- and long-term disability insurance plans.

• Employee Assistance Plan (EAP).

• 401K retirement plans with company matching.

• Employee Referral Bonus Program.