REMOTE Senior Risk Adjustment Coding Consultant (Commercial)
About the position
CSI Companies is actively seeking a REMOTE SENIOR Risk Adjustment Medical Coder for a HHS IVA RADV Audit. This position is designed for individuals who are experienced in risk adjustment coding and are looking for a flexible work environment. The coder will be required to work a minimum of 20 hours per week, with both full-time and part-time positions available. This role is 100% remote, allowing you to work from the comfort of your home. The pay structure is based on an hourly model, with compensation ranging from $26 to $30 per hour depending on experience. Additionally, paid training will be provided to ensure that all coders are well-prepared for their responsibilities. In this role, you will be responsible for assigning appropriate ICD-10-CM codes and mapping them to risk adjustment models as applicable. You will also need to assign Event codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes. Compliance with the Standards of Ethical Coding as set forth by the American Health Information Management Association is crucial, as is adherence to official coding guidelines and HIPAA laws and regulations. You will support chart audit processes, including auditing provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare & Medicaid Services (CMS) risk adjustment guidelines. Acting as a liaison between internal departments and external entities on regulatory data validation audits, including HHS RADV, will also be part of your responsibilities. Moreover, you will perform root cause analysis to identify issues that may contribute to coding and documentation deficiencies, as well as conduct internal and external coding quality reviews to validate correct ICD-10-CM code assignments. Maintaining quality and production standards is essential, with a minimum QA passing requirement of 95% accuracy on all projects. Staying current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements is also a key aspect of this position.
Responsibilities
Assign appropriate ICD-10-CM codes, mapping to risk adjustment models as applicable
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Assign Event codes when documentation in the record is inadequate, ambiguous, or otherwise unclear for medical coding purposes
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Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines
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Comply with HIPAA laws and regulations
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Support chart audit processes, including audit provider and vendor documentation of ICD-9 and ICD-10 codes to ensure adherence with Center for Medicare & Medicaid Services (CMS) risk adjustment guidelines
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Act as a liaison between internal departments and external entities on regulatory data validation audits (including HHS RADV)
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Perform root cause analysis to identify issues that may contribute to coding and documentation deficiencies
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Perform internal and external coding quality reviews to validate correct ICD-10-CM code assignments
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Maintain quality and production standards required by company - all medical coders must maintain minimum QA passing requirements
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Remain current on diagnosis coding guidelines and risk adjustment reimbursement reporting requirements
Requirements
Active certified coder certification (CRC, CPC, CCS, CCS - P) through AHIMA or AAPC
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Minimum 3 years of experience as a certified coder
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Minimum 5 years of risk adjustment experience
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A minimum of 3 years experience Risk Coding Commercial Charts
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Ability to code using an ICD-10-CM code book
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Computer proficiency (including MS Windows, MS Office, and the Internet)
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High-speed Internet access
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Ability to commit to a 20 hours per week work schedule for the duration of the audit
Nice-to-haves
Knowledge of HIPAA, recognizing a commitment to privacy, security and confidentiality of all medical chart documentation
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Prior experience with ACA HHS IVA RADV projects
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Strong clinical knowledge related to chronic illness diagnosis, treatment and management
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Extensive knowledge of ICD-10-CM outpatient diagnosis coding guidelines
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Reliability and a commitment to meeting tight deadlines
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Personal discipline to work remotely without direct supervision
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Exemplary attention to detail and completeness
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Strong organization, interpersonal, and customer service skills
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Written and oral communication skills
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Analytical skills
Benefits
Paid training
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Long term contract position
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Flexible working schedule
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