Compliant query generation, as needed
Escalate any educational opportunities to improve clinical documentation in compliance with ICD-10 CM coding guidelines, internal protocols, and CMS and payer guidelines
Responsibilities will include
Concurrent review and feedback after face-to-face visit (in person or via telehealth) to ensure coding and documentation accurately captures patient health status
Compliant query generation when conflicts or clarification is needed in documentation, prior to claim submission
Corrected claim generation when compliant note amendments are completed
Provide guidance to field staff and practices regarding general coding, documentation and risk adjustment best practices
Partner with internal stakeholders to improve reporting and analytics tools to drive improvements in the accuracy and completeness of clinical documentation and diagnosis coding
Reviews annual mapping updates of ICD-10 CM crosswalk from CMS Website
Other duties as assigned
What makes you a fit for the team
You are excited to work in a startup environment, with the ambiguity and shifting priorities that might come with it at times
You are willing to go the extra mile no matter what
You are passionate about our mission to improve the lives and healthcare outcomes of marginalized communities
Desired skills and experience
Required
Current certification as a Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), or equivalent
3+ years of recent, relevant work experience in medical coding, preferably in risk adjustment
Thorough understanding of medical coding guidelines and regulations including compliance, reimbursement, and the impact of diagnosis documentation on risk adjustment payment models
Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts
Preferred
Experience in pre-visit planning and provider education
Experience with athenahealth
Experience with GSuite and Google applications
Salary ranges are based on role, level, and location, and reflect the minimum to maximum target for new hire pay in each position. Depending on the role, you may also be eligible for bonus, equity, and benefits. Where you fall within the range depends on factors such as your location, skills, experience, and relevant education or training. Our talent team is happy to share more details on the specific range for your location during the hiring process.
Pay Transparency
$32—$36 USD