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OVERVIEW

Joining Redeemer Health means becoming part of an inclusive, supportive team where your professional growth is valued. Our strength comes from bringing different perspectives and talent to our workforce, spanning PA & NJ. We offer programs that set up new team members for long-term success including education assistance, scholarships, and career training. With medical and dental coverage, access to childcare & fitness facilities on campus, investment in your retirement, and community events, your career at Redeemer is more than a job. You’ll discover a commitment to quality care in a safe environment and a foundation from which you can provide and receive personalized attention. We look forward to being a part of your professional journey. We invite you to apply today.

SUMMARY OF JOB

The Certified Risk Adjustment Coding/Audit Reviewer is a physician facing position and must have extensive knowledge in reviewing a medical charting and ability for formulate comprehensive proactive education and audit with needed remediation upon those findings. Expertise in reviewing and revalidating accurate medical codes and diagnoses performed by physicians and other qualified healthcare providers in the office and patient home setting (e.g. outpatient setting) A sound knowledge of medical coding (https://www.aapc.com/certification/medical-coding-certification.aspx) guidelines and regulations including compliance and reimbursement – allowing a CRC to understand the impact of diagnosis coding on risk adjustment payment models. Understand the audit process for risk adjustment models. Ability to identify and communicate documentation deficiencies to providers to improve documentation for accurate risk adjustment coding. Knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses.

The Certified Risk Adjustment Coding/Audit Specialist analyzes and translates concurrent, prospective and retrospective medical and clinical diagnoses and procedures, injuries, and illnesses into Medical Risk Adjustment (MRA) ICD - 10 codes and Hierarchical Condition Categories (HCC’s) Completes assignments with an emphasis on completeness, accuracy, and supporting clinical care plans to Risk Adjustment Data Validation (RADV) Timelines. Medicare and Medicaid regulations and billing guidelines and AMA’s publication CPT Assistant. Responsible for meeting quality expectations for data abstraction, coding, and meets HRHS’s expected productivity standards. Performs assigned duties in accordance with outpatient specific coding policies and procedures. Responsible for remaining current with latest healthcare technology and coding advice through reading available coding literature, attendance of seminars and in-services, internet research and other educational resources. Performs duties in support of the HRHS mission to ensure the highest quality of patient care in an economically sound and efficient manner.

CONNECTING TO MISSION:

All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holitisic Approach, Stewardship, and Collaboration are present in our interactions with one another and in the services we provide.

RECRUITMENT REQUIREMENTS

High School Graduate. Certified coder CPC or CCS-P, and AAPC CRC certification. 2+ years coding, Medicare Risk Adjustment/Medicare Advantage and/or clinical. Plans experience. Familiarity with Evidence Based Medicine documentation. 1+ years of quality improvement experience, or other relevant experience preferred. Experience working in health care and insurance Industry. Knowledge base of clinical standards of care, preventive health standards and Medicare Risk Coding. The ideal candidate for this position has a knowledge of how to read a medical chart and assign the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., HCC, CDPS, and HHS Risk Adjustment).

LICENSE AND REGULATORY REQUIREMENTS:

Education

+ High School / GED

+ 2 -4-year relevant work experience

+ AAPC or AHIMA Certification (CPC, CRC, CCS) REQUIRED

+ Certified Risk Adjustment Coder – PREFERRED

Knowledge

+ Knowledgeable of medical and clinical terminology, disease processes and pharmacology

+ ICD-10-CM Proficient

Must be detail oriented and have basic computer skills. Experience with computerized encoders and abstracting systems preferred.