Risk Adjustment Coder, Professional Billing II

🔥 17 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

Founded 2017

🏥 Healthcare

💰 Grant on 2024-08

Healthcare

Prisma Health is a large integrated health system that operates hospitals, clinics, and related patient services in South Carolina and Tennessee. The organization employs nearly 32,000 people and focuses on providing clinical care, nursing and allied health services, and workforce training (e. g. , nurse residency programs), with an emphasis on patient-centered care and community health. The company posts career opportunities across administrative, clinical, technical, and support roles and highlights benefits, hiring events, and candidate resources on its careers site.

📋 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. • All team members are expected to be knowledgeable and compliant with Prisma Health's values. • 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. • Performs other duties as assigned.

🎯 Requirements

• Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred • Experience - Five (5) years professional fee coding experience • Required Certifications, Registrations, Licenses - Certified Professional Coder (CPC), and 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. • Participates in education offerings. • Participates in monthly meetings.