Risk Adjustment Clinical Reviewer Specialist-1

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

• Review, analyze and code patient medical records based on client specific guidelines for the project.
• Follow ICD-10-CM Coding Guidelines and interpret coding guidelines for accurate code assignment.
• Follow Risk Adjustment Data Abstraction Rules.
• Prospective & Concurrent Reviews
• Run queries
• Follow client/project specific guidelines.
• Will be required to maintain a quality score of 95% or higher.
• Will be required to maintain an ongoing productivity level based on project requirements.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information.

• All coders MUST be certified through either the AAPC or AHIMA. (Apprenticeship designations are not accepted.)
• Acceptable credentials would be CPC, CRC, COC, RHIA, RHIT, CCS, or CCS-P.
• Must have at least a minimum of 2 years of HCC coding experience doing Prospective and Concurrent reviews.
• Experience running and sending queries.
• Must have working knowledge and experience with systems such as EMRs, Billing systems, abstraction platforms, etc.
• Must have a phone, reliable internet connection and current coding materials such as ICD-10-CM coding references.
• Team Member must be able to work from home and be independent in their coding skills.
• Must be proficient in Microsoft programs like Excel and Outlook.
• Ability to communicate effectively and professionally both verbally and written.
• Ability to coordinate, analyze, observe, make decisions, and meet deadlines.
• May be required to perform other duties as assigned by Leadership Team Member.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.