Risk Adjustment Coder

Job Description Employment Duration: 3 months Location: Fully Remote Openings: 2 The Health Information Coder I is an entry‑level coder with basic knowledge and skill set to utilize ICD‑10‑CM, CPT, and HCPCS classification systems to code across various healthcare settings, including outpatient, emergency department, and ancillary services. This role ensures coding accuracy, compliance with regulatory guidelines, and adherence to UCSF policies, supporting proper reimbursement and revenue cycle integrity. The Coder I collaborates with healthcare providers, revenue cycle teams, and compliance departments to resolve documentation issues and maintain high standards of coding performance. The position is hybrid and may require travel to UCSF Health for business purposes. The incumbent must provide a safe and private home office environment for conducting UCSF business. Key Responsibilities Assign accurate ICD‑10‑CM, CPT, and HCPCS codes for diagnoses, procedures, and services based on documentation in the medical record, focusing on ICD‑10‑CM codes that map to CMS‑defined Hierarchical Condition Categories (HCCs). Ensure ICD‑10‑CM and CPT coding compliance with federal regulations, payer policies, UCSF standards (including UCSF HCC Coding Guidelines), and industry guidelines, including LCD/NCD requirements. Review medical records and abstract necessary information to ensure documentation supports assigned codes for billing and reimbursement. Identify and add ICD‑10‑CM diagnosis codes supported by clinical documentation, with a focus on codes that map to HCC categories. Resolve coding edits, discrepancies, and denials in collaboration with appropriate departments to ensure accurate claim submission. Maintain productivity and quality benchmarks, achieving organizational accuracy standards and ensuring timely completion of coding assignments. Participate in ongoing education and training to stay updated on changes in ICD‑10‑CM, CPT, HCPCS, regulatory compliance, and CMS‑HCC Risk Adjustment models. Work with revenue cycle teams, providers, and compliance staff to clarify documentation and coding‑related issues. Participate in special projects as directed, including data attestations in payor data systems, targeted reviews of provider documentation, and preparation of training materials. Use electronic medical records, coding software, and hospital billing systems to perform daily coding activities. Interact with internal and external UCSF Health staff and customers. Maintain satisfactory time and attendance. Demonstrate understanding of ICD‑10‑CM, CPT, and HCPCS coding classification systems, with a focus on diagnoses that map to CMS‑HCC categories. Perform data searches and troubleshoot computer issues. Maintain patient confidentiality and IT security. Treat others with respect and work effectively as part of a team. Train others as requested. Follow safety and infection control guidelines. Maintain equipment and work area. Comply with the UCSF Health dress code. Perform other duties as assigned. Qualifications Required Qualifications Certified Risk Adjustment Coder (CRC) High school graduation or G.E.D 1–3 years of healthcare coding or related healthcare experience Ability to meet daily production requirements with a minimum accuracy rate of 95% Basic EHR and encoder skills Basic computer skills, including Windows, Word, and Excel Ability to analyze information, make decisions, and exercise independent judgment Knowledge of medical terminology, medical abbreviations, disease processes, anatomy, and physiology Knowledge of ICD‑10‑CM, ICD‑10‑PCS, and CPT classification systems COC, CPC, CCS, CCS‑P, RHIT, RHIA, or other coding certification, or agreement to obtain certification within six months of hire Preferred Qualifications Knowledge of HIMS database systems. Knowledge of HIMS procedures. Benefits & Compensation Salary range is determined by UC policy and the current salary level of individuals in similar UCSF roles. Placement within the salary range is influenced by work experience, internal equity, and collective bargaining agreement rules for union‑covered roles. For more information on total compensation, visit https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html. Additional benefits include health, dental, and vision coverage, retirement plans, paid time off, and professional development opportunities. About UCSF The University of California, San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate‑level education in the life sciences and health professions, and excellence in patient care. UCSF is the only campus in the 10‑campus UC system devoted exclusively to the health sciences. Equal Employment Opportunity The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law. #J-18808-Ljbffr