Medical Coding Reviewer – Risk Adjustment

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $28 - $34 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🏥 Medical Billing and Coding

🚫👨‍🎓 No degree required

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GuideWell Source

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

⚕️ Healthcare Insurance

🏛️ Government

🏢 Enterprise

Healthcare Insurance • Government • Enterprise

GuideWell Source is a company within the GuideWell Family that focuses on accelerating innovative health solutions to market, transforming and reshaping the health industry. It specializes in healthcare delivery, providing new models and superior outcomes for patients. The company emphasizes consumerism in healthcare, engaging clients in meaningful ways. GuideWell Source offers healthcare insurance, protecting employers and consumers with coverage plans and services. The company also provides administrative and claims processing services for state and federal Medicare and Medicaid programs, establishing itself as a trusted business partner in the healthcare sector with a focus on operational excellence.

📋 Description

• Review inpatient and/or outpatient medical records to identify and assign relevant diagnosis codes using ICD-10 classification systems to ensure accuracy and compliance of risk adjustment. • Review and validate provider-submitted and/or vendor-submitted medical record documentation and ICD-10 diagnosis codes to identify and correct any inaccuracies or discrepancies to ensure accuracy and compliance of risk adjustment. • Responsible for meeting production targets while adhering to strict quality audit accuracy of 95%. • Provide non-production level support by documenting coder observations that would not otherwise be captured through the diagnosis coding. • Assist Provider Educator during audit results presentation with provider groups by answering diagnosis coding questions. • Administrative duties including updating SOPs, DTPs and other related documents. • Participating in process improvement initiatives such as but not limited to coding tool enhancements.

🎯 Requirements

• 2+ years related work experience • High school diploma or GED • Required active Certified Professional Coder from American Association of Professional Coders (CPC) and/or CCSP OR (AAPC) or American Health Information Management Association (AHIMA) • Ability to work independently in a remote work environment. • Proficient with ICD-10-CM Guidelines for coding and reporting. • Previous work experience in a production-based environment. • Strong understanding of medical terminology, abbreviations, body systems/anatomy, physiology and concepts of disease processes. • Intermediate level of Microsoft Office proficiency (Word, Excel, Outlook, PowerPoint).

🏖️ Benefits

• Medical, dental, vision, life and global travel health insurance • Income protection benefits: life insurance, short- and long-term disability programs • Leave programs to support personal circumstances • Retirement Savings Plan including employer match • Paid time off, volunteer time off, 10 holidays and 2 well-being days • Additional voluntary benefits available; and a comprehensive wellness program