Professional Alternatives

Job ID#: 9437

Duration: Temp-to-hire
Compensation: $25-30/hour

Nurse Risk Adjustment Coding Specialist is responsible for the review of medical records to ensure the compliant submission of ICD-10 diagnosis codes for chart submissions and external audits.

Job Duties:

  • Coder will abstract diagnostic data and report ICD-10 codes and other information from electronic and handwritten medical records in accordance with established CMS and plan guidelines
  • Coder will assist with any second level audits to ensure quality and oversight with the vendor’s coding performance
  • Coder will assist the team with Risk Adjustment Data Validation (RADV) audit preparation and CMS RADV audits
  • Coder will assist with any record retrieval required for vendor activities or other regulatory audits Works collaboratively with UM/Care Management regarding the patient severity and any complexity treatment issue identified
  • Assist leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
  • Other duties as assigned

Minimum Qualifications:

  • Must be an RN, BSN preferred
  • Coding Certification (CPC, RHIT, CCS, or CCS-P), CRC along with one of the required certifications is preferred
  • 1+ year(s) of HCC coding experience

Required Knowledge, Skill & Abilities:

  • Medicare Risk Adjustment (HCC) coder with a strong knowledge of ICD-10-CM diagnostic coding
  • Strong knowledge of base medical terminology, medical abbreviations, pharmacology, and disease processes
  • Familiarity with common EMR applications and proficient in Microsoft Office (Word, PowerPoint, Excel, Outlook)
  • Excellent verbal and written communication skills
  • Team-player with self-motivation, problem-solving, and attention to detail
  • Ability to meet productivity and accuracy standards
  • Ability to defend coding decisions to both internal and external audits

Preferred Knowledge, Skill & Abilities:

  • Understands the impact of ICD-10 codes on the CMS HCC risk adjustment model
  • Knowledge of RAPS / EDS data types and other Risk Adjustment audits
  • Demonstrated ability to gather and analyze data to identify trends


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