HCC / Risk Adjustment Medical Coders

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Advantmed

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

💼 Consulting

🛡️ Insurance

📦 Logistics

💰 Venture Round on 2016-12

Consulting • Insurance • Logistics

Advantmed is a company that specializes in providing integrated solutions to healthcare organizations, aiming to enhance the performance of health plans and providers. The company focuses on key areas such as risk adjustment, quality improvement, and health assessments, using its Elevate^ platform to deliver real-time data visibility and insights. With a commitment to market-leading accuracy, flexibility, and transparency, Advantmed partners with healthcare clients to improve outcomes, financial performance, and data accuracy. Their comprehensive services cater to both health plans and providers, enhancing member engagement, identifying care gaps, and ensuring accurate reimbursement and care delivery.

📋 Description

• Review and accurately code medical records and encounters for diagnoses and procedures related to Risk Adjustment and HCC coding guidelines. • Ensure coding is consistent with ICD-10-CM, CMS-HCC, and other relevant coding guidelines. • Validate and ensure the completeness, accuracy, and integrity of coded data. • Identify and resolve coding discrepancies or discrepancies between clinical documentation and diagnosis coding. • Stay up-to-date with the latest coding guidelines, rules, and regulations related to Risk Adjustment and HCC coding. • Adhere to all compliance and HIPAA regulations to maintain data security and patient confidentiality. • Collaborate with healthcare providers, physicians, and other team members to clarify documentation and resolve coding queries. • Participate in coding education and training programs to enhance coding skills and knowledge. • Prepare and submit reports related to coding activities, coding accuracy, and any coding-related issues or trends. • Assist in internal and external coding audits to ensure the quality and compliance of coding practices. • Identify opportunities for process improvement and efficiency in the coding process. • Offer suggestions to enhance coding documentation and accuracy.

🎯 Requirements

• Minimum CPC or CCS certification from AHIMA or AAPC is required. Higher-level certifications such as CRC (Certified Risk Adjustment Coder) is a significant advantage. CPC-A (Apprentice) certification will not be considered for this position. • Minimum one to two years of experience in Risk Adjustment and HCC coding in a healthcare setting. • Strong knowledge of ICD-10-CM coding guidelines and CMS-HCC risk adjustment methodology. • Familiarity with electronic health record (EHR) systems and coding software. • Excellent attention to detail, analytical skills, and ability to work independently. • Strong communication and interpersonal skills for collaboration with medical professionals and team members. • Understanding of compliance and confidentiality regulations, including HIPAA.