We're hiring a Risk Coding Representative to join our team in Verona, NJ.

Position Overview:

Responsible for performing in depth review of physician and hospital records to determine the completeness and accuracy of HCC and Rx-HCC coding by ensuring the assignment ICD-10 codes selected are supported by clinical documentation and coding guidelines. This is a full-time position, on-site in Verona, NJ with a pay rate of 45,000-50,000 annually.

Job Responsibilities:

• Serve as the subject matter expert on HCC documentation requirements and ICD-10 coding guidelines.
• Strong understanding of the HCC concepts and impact on Population Health Risk Adjustment reimbursement initiatives.
• Assist in the development and implementation of strategy for VMG's risk adjustment and coding accuracy ensuring compliance with regulatory requirements.
• Effectively use computer assisted coding tools to review and interpret medical records and apply knowledge of coding principles to validate missing, incomplete, or incorrect CPT and diagnosis codes.
• Recognize clinical signs, symptoms, and indicators for gaining the highest level of specificity via Provider queries to appropriately represent our patient's disease burden for accuracy of risk score assignment
• Engage with medical practitioners to provide feedback and educational resources on best practices for medical coding to increase revenue enhancement opportunities.
• Communicate and interact with Practice Supervisors, Providers, billing and/or coding teams regarding proper coding and documentation requirements and processes
• Ensure diagnosis coding and clinical documentation criteria, rules and guidelines have been met in accordance with CMS guidelines
• Assists in orienting, training, and mentoring new staff and physicians.
• Review HCC suggestions from 3rd party HCC platforms daily. Advance suggestions to providers base on patient?s documented history. Suggestions must be reviewed prior to a patient next visit.
• Demonstrates knowledge of medical terminology, anatomy, and physiology.
• Follows up on all outstanding and incomplete provider billing summaries to ensure proper coding.
• Ascertain that coding efficiency and accuracy are improved by performing independent audits of physician records.
• Maintain at least 95% on both coding accuracy and completeness audits.
• Effective communication, relationship-building and interpersonal skills.
• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Personal Health Information.
• Performs other duties and responsibilities as required.