Senior Medical Chart Review Specialist

5 days ago

Cleveland, Queensland, Australia beBeeRisk Full time US$25,540 - US$38,592
Job Title: Risk Adjustment Coder

Overview:

The Risk Adjustment Coder is responsible for performing chart retrieval, medical record review, HCC identification, and data quality oversight to mitigate risk and enhance revenue recovery for Medicare and ACA services.

Key Responsibilities:

  • Oversee the chart review lifecycle from scheduling access, collecting images, coding chart data, developing supplemental records, and submitting RAPS files to CMS.
  • Determine the adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment.
  • Serve as a resource regarding quality coding per guidelines and supervise internal and external coders.
  • Develop policies, procedures, operational workflows, auditing worksheets, and other documentation to support department processes concerning risk adjustment and RADV activities.
  • Oversee periodic audits of revenue realization activities and implement quality oversight on retrospective chart review processes, home visits, and bidirectional reviews.
  • Act as the primary liaison with the provider community and represent the organization at Health Plan Alliance Coding workshops.
  • Educate and provide feedback to provider offices about medical record documentation and coding issues to facilitate accurate claims submissions and reduce RADV risk exposure.
  • Ensure all Level 1 coders maintain updated knowledge of coding requirements through continuing education and certification renewal.
  • Prepare educational materials on coding requirements and conduct training to ensure accuracy of the medical records review process.
  • Coordinate user group meetings, conference calls, and training sessions and supply attendance documentation to Compliance.

Requirements:

  • Associate degree or equivalent combination of education and experience.
  • Five years of experience including leadership, medical chart reviews, risk adjustment experience with in-depth knowledge of CPT coding, ICD-9/10, medical terminology, and solid understanding of HCC coding.

Other Skills, Competencies, and Qualifications:

  • Ability to obtain Certified Risk Adjustment Certification (CRC) from the American Academy of Professional Coders (AAPC) within six months of hire.
  • Demonstrated knowledge of Microsoft Office and software for electronic processing of medical records.
  • Up-to-date knowledge of risk adjustment HCC processing concerning ICD-9/10 coding guidelines.
  • Current knowledge of medical coding concepts, techniques, and principles in risk management.
  • Understanding of medical chart review processes and ability to translate business needs into solutions/actions.
  • Strong attention to detail to determine appropriate health conditions and codes for RADV submissions.
  • Ability to organize and manage time effectively in a fast-paced environment.

Benefits:

  • Competitive salary range of $25.54 - $38.32 per hour.
  • Basic Life and AD&D insurance.
  • Supplemental Life and AD&D insurance.
  • Dependent Life Insurance.
  • Short-Term and Long-Term Disability insurance.
  • Additional insurance options (e.g., Accident, Hospital Indemnity, Critical Illness).
  • Retirement Savings Plan.
  • Flexible Spending Accounts – Healthcare and Dependent Care.
  • Employee Assistance Program (EAP).
  • Identity Theft Protection.
  • Pet Insurance.
  • Education Assistance.
  • Daily Pay.

Equal Opportunity Employer/Veterans/Disabled.

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