Overview
Job Title: HCC Risk Adjustment Coder
Location: Hybrid - Verona, NJ & Remote
Schedule: Monday through Friday; 40 hours/week
Employment Type: Full Time; Exempt
Reports To: Director, Clinical Quality & Transformation
The HCC Coder is an essential administrative member of our dynamic health care team, focused on supporting the activities of the Population Health Department through various clerical duties. Excellent time management and an ability to work as part of a team are essential skills for this role. Willing to train the right candidate.
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES (included but not limited to):
- Accurate data management including the retrieval of hospital records and obtaining reports from specialists and health care providers.
- Manage data entry on multiple spreadsheets to track workflows and outcomes.
- Ability to review documentation and abstract all codes with specific emphasis on identifying the most accurate severity of illness according to CMS HCC (Hierarchical Conditions Categories) guidelines.
- Effectively uses computer assisted coding tools to review and interpret medical records and applies in-depth knowledge of coding principles to validate missing, incomplete or incorrect CPT and diagnosis codes.
- Abstracts, sequences and assigns diagnosis and procedures codes according to CMS HCC and all CPT and ICD 9 & 10 guidelines.
- Demonstrates advanced knowledge of medical terminology, anatomy and physiology.
- Follows up on all outstanding and incomplete provider billing summaries to ensure proper coding.
- Attend training, meetings and presentations associated with the Population Health Department and the Vanova Health organization as required.
- Perform administrative duties including copying, report collation, organizational tasks, and other duties as assigned by Manager.
- 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.
- 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.
- 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.
- Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Personal Health Information.
WORK ENVIRONMENT/PHYSICAL DEMANDS
- Office setting, with extended periods of sitting and computer work
Qualifications
Qualifications:
- Associate’s degree minimum, bachelor’s degree preferred
- Work experience in a community or medical health care setting is a plus.
- Previous HER knowledge required, Athena a plus
- 1+ year of auditing experience
- Proficient use of Microsoft Office Applications (Excel, Word, PowerPoint).
- Coding Certification (CPC, CRC, CCS-P, CCA, RHIT, or RHIA) – highly preferred.
TOTAL REWARDS AT VANOVA HEALTH SOLUTIONS:
At Vanova, we see Total Rewards as more than just a paycheck and recognize that value comes in many forms. It is the full experience of being a part of our incredible team working toward a shared, mission-driven purpose.
We’re proud to offer competitive compensation, health and wellness benefits, a retirement savings plan, time off to recharge, learning opportunities to continually grow, and meaningful work in a collaborative culture that fosters team connection through shared celebrations and appreciation events.
We are committed to investing in the future of our people and focused on expanding our total rewards to support every stage of your journey with us.
- The anticipated pay range for this role is: $23/hr-$25/hr
- This position offers an opportunity for annual target bonus based on individual performance and company financial performance.
- Comprehensive benefits based on eligibility include a 401K retirement savings plan with company match, paid time off, and health benefits (medical, prescription drug, dental and vision insurance).
- Please note that individual total compensation for this position will be determined at the Company’s sole discretion and may vary based on several factors, including but not limited to location, skill level, years and depth of relevant experience, and education.
EEOC Statement: Vanova Health is an Equal Opportunity Employer. We are committed to creating a diverse and inclusive environment and are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
This job description is intended to describe the general nature and level of work performed and is not an exhaustive list of all responsibilities, duties, and skills associated with it. Duties and expectations may be subject to change with or without notice.
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