Medical Coder III-Large Managed Care Company
Fully Remote
One year contract-potential for extension and/or perm hire
Up to $28 an hour/$25 plus health insurance
7-4pm or 8-5pm local time M-F. Potential for 5-10 hours a week of OT
Job Duties:
· Abstract and review inpatient and outpatient medical records for (Hierarchical Condition Categories) HCCs to determine if the HCC is supported by the medical record documentation.
· Knowledge of ICD-9 ICD10 Official Coding Guidelines, AHA Coding Clinic, including Codling clinic clarifications for DOS year under review. CMS RADV Medical Reviewer Guidance (1/10/2020).
Top Skills Required:
· Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits.
· Must have prior vendor coding review experience.
· Must have the ability to complete chart review production requirements.
· Must be experienced in risk adjustment auditing.
· Must possess valid Certified Risk Adjustment Coder credential through AAPC.
· Must have 5+ years of risk adjustment auditing experience with a focus on CMS and HHS RADV reviews.
Must Haves:
· Must have a Certified Risk Adjustment Coder certification (CRC) through AAPC or AHIMA ·
· Will need to maintain a 95% or better coding accuracy performance ·
· Adherence to coding accuracy and productivity policy and procedure regarding diagnosis code completeness and data entry in each coding accuracy review
· Evaluate each medical record to ensure M.E.A.T. criteria support the existence of all submitted diagnosis codes ·
· Review supplied medical records to determine if diagnosis codes mapping to HCCs meet CMS and HHS documentation guidelines ·
· Must have intermediate/advanced Microsoft Excel skills ·
· Well versed in ICD-10 Official Coding Guidelines, AHA Coding Clinic and any Coding Clinic Clarifications for DOS year under review ·
· Should have prior CMS RADV contract level audit and HHS RADV coding experience.
· Should be familiar with Medicare Advantage and ACA lines of business
#ALLJ
Pay: Up to $28.00 per hour
Benefits:
• 401(k)
• Health insurance
Experience:
• RADV Auditing for Medicare/Medicaid: 5 years (Required)
License/Certification:
• CRC Certified Risk Coder-AAPC (Required)
Work Location: Remote