Mercy · 4 hours ago

Risk Adjustment Specialist - REMOTE

Chesterfield, MO

Part-time

Remote

Entry Level

1+ years exp

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Responsibilities

Primarily responsible for providing expertise in reviewing and assigning accurate medical codes for diagnoses, with particular attention to appropriate capture of risk codes based on provider documentation and evidence in the medical record.

Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.

Works independently utilizing advanced, specialized knowledge of medical codes and applicable risk models to assign and sequence appropriate diagnosis billing codes, in compliance with coding standards, in a timely manner.

Reviews recent patient encounters as assigned and prioritized.

Reviews provider diagnosis coding for accuracy and provider documentation for support of selected codes.

Queries/contacts providers for clarification/additional support as needed.

Reviews patient records prior to upcoming visits and/or retrospectively throughout the year as assigned and prioritized.

Examines the medical record to extract applicable diagnostic risk codes, submitting them to providers/payers for review as appropriate.

Working knowledge of anatomy, physiology, and medical terminology necessary to correctly code provider diagnosis.

Ability to work cooperatively and effectively with physicians, coworkers, practice managers, quality and operations teams to drive results and resolve issues.

Fosters a team approach and positive attitude to developing work processes and problem solving.

Adheres to basic ethical principles associated with the appropriate ICD-10 coding guidelines, government and insurance company reimbursements.

Reports any observed questionable activities to the appropriate compliance officer or administrative manager.

Assist with data quality monitoring activities such as identifying and tagging appropriate records for ongoing studies of the Performance Improvement area.

Upholds and adheres to HIPAA regulations.

Maintains up-to-date knowledge of changes and regulations that affect risk coding.

Shares leanings with fellow coders and risk coders within communities and across the Ministry.

Consistently meets or exceeds productivity and quality standards.

Ability to adapt and respond positively to change.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Medical CodingICD-10 CodingCertified CoderAnatomy KnowledgePhysiology KnowledgeMedical TerminologyRisk CodingCompliance KnowledgeData Quality Monitoring