Risk Adjustment Coder II

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🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Medical Billing and Coding

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

📋 Description

• Conducts prospective review to abstract Hierarchical Condition Categories (HCC's) codes to report for the calendar year. • Communicates (via Epic and in person) with providers on any outstanding HCC capture opportunities. • Conducts retrospective reviews to ensure that documentation supports reporting the Hierarchical Condition Category code prior to payor submission. • Conducts prospective review of charts to identify HCC opportunity. • Conducts retrospective review of charts to confirm documentation supports reporting. • Utilizes payor specific software to assist in capturing HCCs. • Communicates with providers about HCC opportunities for improvement. • Identifies suspect conditions that would potentially support reporting an HCC. • Participates in education offerings • Participates in monthly meetings • Performs other duties as assigned.

🎯 Requirements

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned. • Associate degree preferred • Five (5) years professional fee coding experience • Certified Professional Coder (CPC) • Certified Risk Adjustment Coder (CRC) • Knowledge of office equipment (fax/copier) • Proficient computer skills including word processing, spreadsheets, database • Data entry skills • Mathematical skills

🏖️ Benefits

• Inspire health. • Serve with compassion. • Be the difference.