This role can be remote OR hybrid.

POSITION DESCRIPTION:

The Certified Risk Coder responsibilities involve performing medical coding and reviewing medical codes for adherence to risk adjustment models and auditing medical record data to ensure accuracy. This position applies codes and makes assessments according to regulations and IHA’s policies. Responsible to report the results of an audit to the relevant supervisor and ensures compliance with rules related to patient privacy and electronic medical record keeping.

ESSENTIAL JOB FUNCTIONS:

Audits provider documentation to ensure the HCC codes entered by the provider are accurate, coded to the highest level of specificity and meets documentation guidelines.

Assigns appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable.

Reviews diagnosis codes that are passed through NLP software (Lumanent).

Applies Coding Clinic guidance to coding scenarios regarding risk-adjusted diagnosis codes.

Enters charges and diagnosis codes for outpatient and inpatient accounts.

Identifies documentation discrepancies.

Creates relationships with external organizations (i.e. St. Joe’s and HVR) that allow for streamlining and quick resolution of billing matters for patients.

Participates effectively in clinical documentation improvement initiatives and team meetings to promote quality across all projects.

Maintains complete knowledge and complies with all relevant insurance, CPT coding and diagnosis guidelines, disseminating info to staff and providers as necessary.

Attends regularly scheduled meetings.

Coordinates and follows through with special projects as assigned.

Performs other duties as assigned

ORGANIZATIONAL EXPECTATIONS:

Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement.

Must be able to work effectively as a member of the Revenue Site Operations team.

Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers.

Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA’s Employee Handbook.

Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.

Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.

Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.

Uses resources efficiently.

If applicable, responsible for ongoing professional development – maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: High School Diploma or GED

CREDENTIALS/LICENSURE: One of the following certifications: AAPC (CRC), ARHCP (RRC)

MINIMUM EXPERIENCE: 2 years’ experience in the healthcare industry.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

Maintains knowledge on current diagnosis coding guidelines and risk adjustment reimbursement reporting requirements.

Demonstrates the ability to apply the HCC risk adjustment model.

Understands the anatomy, pathophysiology and medical terminology necessary to correctly code diagnoses.

Understands the use of predictive modeling from data captured through risk adjustment coding.

Understands the process for retrospective audits.

Understands disease processes and interactions for common chronic conditions.

Ability to code using an ICD-10-CM code book.

Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, Microsoft Word, Excel, Outlook, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job.

Excellent communication skills in both written and verbal forms, including proper phone etiquette.

Ability to speak before groups of people, either in-person or virtually.

Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.

Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, insurance carriers, outside customers, vendors and couriers.

Good organizational and time management skills to effectively juggle multiple priorities, time constraints and large volumes of work.

Ability to exercise sound judgement and problem-solving skills, specifically as it relates to resolving billing and coding problems.

Ability to handle patient and organizational information in a confidential manner.

Ability to work under minimal supervision.

Successful completion of IHA competency-based program within introductory and training period.

MINIMUM PHYSICAL EXPECTATIONS:

Physical activity that often requires keyboarding, filing and phone work.

Physical activity that often requires extensive time working on a computer.

Physical activity that sometimes requires walking, standing, bending, stooping, reaching and/or twisting.

Physical activity that sometimes requires lifting, pushing and/or pulling under 20 lbs.

Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.

Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.

Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in a typical office environment and requires frequent change and significant interaction with people (many of whom are not familiar with the medical billing and reimbursement process) which can be stressful at times.