Risk Adjustment Coder, Professional Billing II

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

📋 Description

• Executes prospective reviews to extract Hierarchical Condition Categories (HCC) codes for reporting within the calendar year.

• Engages with providers, both through Epic and in-person interactions, regarding any outstanding HCC capture opportunities.

• Performs retrospective reviews to verify that documentation substantiates the reporting of Hierarchical Condition Category codes before submission to payors.

• All team members are expected to possess knowledge of and adhere to Prisma Health's values.

• Conducts prospective chart reviews to pinpoint HCC opportunities.

• Undertakes retrospective chart reviews to ensure documentation is aligned with reporting requirements.

• Leverages payor-specific software to aid in HCC capture.

• Communicates with providers about opportunities for HCC improvement.

• Identifies potential conditions that could support HCC reporting.

• Carries out additional duties as assigned.

⛳️ Requirements

• Education - High School diploma or equivalent, or post-high school diploma/highest degree attained. An Associate degree is preferred.

• Experience - Minimum of five (5) years of professional fee coding experience.

• Required Certifications, Registrations, Licenses - Certified Professional Coder (CPC) and Certified Risk Adjustment Coder (CRC).

• Familiarity with office equipment such as fax machines and copiers.

• Proficient in computer skills, including word processing, spreadsheets, and databases.

• Competent data entry skills.

• Strong mathematical abilities.

🏝️ Benefits

• Inspire health.

• Serve with compassion.

• Be the difference.

• Participate in educational offerings.

• Attend monthly meetings.