Location: Montebello, CA

Schedule: Full Time - 40 hours, between 7am to 5pm

Pay: $26 - $30 - Depending on Experience

Job Type: Temporary Assignment

Job Summary: The Coder, Risk Adjustment position provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient. The Risk Adjustment Coder is responsible for evaluating the accuracy and consistency of coded clinical data quality results and reports in accordance with all applicable federal, state and county regulations/laws related to coding, auditing, and clinical documentation guidelines for the various risk adjustment models. May participate in developing, presenting, and disseminating provider communication and other activities related to clinical documentation.

Key Responsibilities: 

 1.  Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC). 

2.  Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines. 

3. Check medical charts to ensure accurate coding for all diagnoses, procedures, and level of care. 

4  Provides feedback regarding diagnosis coding and documentation gaps. 

5.  Complies with coding standards, ethical guidelines, and legal requirements to manage risk and improve outcomes. 

6.  Assists with audits and compliance activities. 

7.  Assists in quality improvement and practice management functions.   

8.  Collaborates with other teams on quality-related projects. 

9.  Provides clerical support to Provider Workgroups, Clinical Action Teams and assists meetings as requested. 

10. Meet productivity and quality standards. 

11. Perform other duties as assigned.

Work Environment:

 1.    Work is in an office environment, climate controlled through central air conditioning. 2.    Work may require travel to physician office site(s).

Required Skills and Abilities:

1.  Knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated / Assessed / Addressed, Treated) standards. 

2.  Understanding of the various risk adjustment models (CMS/HCC HHS/HCC, and Rx/HCC). 

3.  Proficient with Microsoft Office (Excel, Outlook, PowerPoint, Word). 

4. Excellent communication skills – oral and written. 

5. Ability to plan, prioritize and schedule multiple work assignments; high degree of organization and time management skills.

Physical Requirements:

1. Work is sedentary involving sitting at a PC for long periods of time. 

2. Ability to sit, stand, stoop, reach, lift (up to 10 pounds), bend, etc., hand and wrist dexterity to utilize computer. 

3. Does require travel to sites/program and special functions.