A small managed care company is looking for a Coder/CDI Specialist to focus on Medicare members.
Risk adjustment coding professional who has strong knowledge of HCC, RAF methodology, and CMS risk adjustment guidelines and is comfortable serving as a senior-level resource for coding quality and provider education.
Key Responsibilities Audit and perform QC of coding team output for accuracy and compliance with HCC/ICD-10-CM guidelines
Conduct second-level reviews and serve as an escalation point for complex charts and coding questions
Identify documentation gaps and communicate directly with providers regarding documentation queries
Educate physicians and clinical teams on documentation practices that support accurate risk adjustment coding
Track coding errors, trends, and quality patterns and report findings
Identify opportunities related to over/under-utilization and collaborate with teams and provider groups on solutions
Support development of processes around right-coding, appropriate utilization, and closing care gaps
Work independently as a senior-level coding and auditing resource
Requirements Medicare Advantage / Managed Care experience required
3 years of Managed Care experience preferred
Strong knowledge of HCC hierarchy, RAF methodology, and CMS risk adjustment guidelines
Experience communicating directly with physicians and clinical teams
Ability to identify coding and documentation gaps and recommend solutions
Dual-eligible or FIDE-SNP experience is a plus
#J-18808-Ljbffr