Certified Coder - Risk Adjustment (Hybrid in SD)

Caring. Connecting. Growing Together.

Member of the Performance and Risk Adjustment team. Conducts chart review to code for diagnoses and quality. Monitors performance and participates in improvement initiatives in conjunction with Provider Relations, health plans and providers.

Primary Responsibilities:

• Generates reports for department workflow, production, quality monitoring and performance improvement. Participates in formulating improvement initiatives/solutions and assists with execution
• Reviews AWVs and other charts for HCC diagnoses and quality codes and processes them into the tracking programs. Recommends training opportunities and participates in provider training as needed. Audits and interfaces with outside coding vendors
• Participates in webinars, conferences and conducts research as needed to stay abreast of IHA/NCQA/CMS requirements
• Serves as the user expert for software systems. Audits software accuracy from time to time and participates in testing. Attends user meetings and reports systems issues to the vendor
• Tracks and submits audit data for program compliance
• Performs other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associate's Degree with equivalent combination of experience in healthcare and/or information systems
• Completed coursework in coding
• Coding certification
• 3+ years of experience in the healthcare industry
• Experience working with CPT and ICD-9 codes and reading claims forms/reports
• Knowledge of managed care concepts and healthcare delivery systems; understanding of health insurance industry and products
• Proven solid computer literacy, including competence with database and spreadsheet programs. Microsoft Office products familiarity
• Proven excellent organizational and interpersonal skills
• Proven organized self-starter with good follow through. Ability to work with changing priorities and varying deadlines

Additional Position Evaluation Factors:

• Impact of Decisions: Errors may have serious effects and could be costly
• Internal/External Contacts: This position interacts with both internal and external clients. Examples of this are vendors, auditors, association staff and providers on occasion.
• Supervision Given/Received: Non supervisory reports to the Director of Network Management.