Medical Coder III-Large Managed Care Company

Fully Remote

One year contract-potential for extension and/or perm hire

Up to $28 an hour/$25 plus health insurance

7-4pm or 8-5pm local time M-F. Potential for 5-10 hours a week of OT

Job Duties:

· Abstract and review inpatient and outpatient medical records for (Hierarchical Condition Categories) HCCs to determine if the HCC is supported by the medical record documentation.

· Knowledge of ICD-9 ICD10 Official Coding Guidelines, AHA Coding Clinic, including Codling clinic clarifications for DOS year under review. CMS RADV Medical Reviewer Guidance (1/10/2020).

Top Skills Required:

· Must have prior experience with CMS Contract Level Risk Adjustment Data Validation Audits (RADV) and HHS RADV audits and IPM audits.

· Must have prior vendor coding review experience.

· Must have the ability to complete chart review production requirements.

· Must be experienced in risk adjustment auditing.

· Must possess valid Certified Risk Adjustment Coder credential through AAPC.

· Must have 5+ years of risk adjustment auditing experience with a focus on CMS and HHS RADV reviews.

Must Haves:

· Must have a Certified Risk Adjustment Coder certification (CRC) through AAPC or AHIMA ·

· Will need to maintain a 95% or better coding accuracy performance ·

· Adherence to coding accuracy and productivity policy and procedure regarding diagnosis code completeness and data entry in each coding accuracy review

· Evaluate each medical record to ensure M.E.A.T. criteria support the existence of all submitted diagnosis codes ·

· Review supplied medical records to determine if diagnosis codes mapping to HCCs meet CMS and HHS documentation guidelines ·

· Must have intermediate/advanced Microsoft Excel skills ·

· Well versed in ICD-10 Official Coding Guidelines, AHA Coding Clinic and any Coding Clinic Clarifications for DOS year under review ·

· Should have prior CMS RADV contract level audit and HHS RADV coding experience.

· Should be familiar with Medicare Advantage and ACA lines of business

#ALLJ

Pay: Up to $28.00 per hour

Benefits:

• 401(k)
• Health insurance

Experience:

• RADV Auditing for Medicare/Medicaid: 5 years (Required)

License/Certification:

• CRC Certified Risk Coder-AAPC (Required)

Work Location: Remote