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Risk Adjustment Educator - San Antonio, United States - Gonzaba Medical Group
Description
** Risk Adjustment Educator (Location 933 Pleasanton Rd, 78214)**
**Job Category****:** ADMINISTRATIVE **Requisition Number****:** RISKA002273 Showing 1 location **Job Details**
**Description**
**Summary:** Evaluates medical record documentation and charge ticket coding to optimize reimbursement by ensuring that diagnostic and procedural codes and other documentation accurately reflect and support the outpatient visit with the focus being primarily on HCC acuity diagnosis coding and documentation, and to ensure that data comply with legal standards and guidelines. Interprets medical information such as diseases or symptoms, and diagnostic descriptions and procedures for a given visit to accurately assign and sequence the correct ICD-10-CM, HCPCS and CPT codes.
**Duties:** All duties performed will be done accurately and in a timely manner.
1. Provides skilled and specialized work in documentation and coding for medical billing of diagnoses and procedures using ICD-10-CM, CPT and HCPCS codes on all Managed Care patient fee tickets/attestations and enters all charges for Managed Care patient office visits with a primary focus on accurate HCC diagnosis coding into the vital works on computer software.
2. Review, interpret and assign diagnostic, procedural and evaluation & management codes based upon medical record documentation according to correct coding principles. Utilizing 2021 Documentation Guidelines for Evaluation and Management Services.
3. Selects correct ICD-10-CM (diagnostic), CPT (procedural) and HCPCS codes based upon interpretation of operative procedure and correct coding principles. Remains up to date on all coding changes and usage.
4. Maintain the highest level of professionalism in the communications and interactions with the physicians, nursing, front office, medical records, billing and other departmental staff.
5. Maintain compliance with Gonzaba Medical Group policies, Official Coding Guidelines and the Gonzaba Medical Group Coders Pledge.
6. Adhere to all confidentiality and HIPAA requirements as outlined within Gonzaba Medical Group Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered.
7. Communicate daily with your Supervisor/Lead and provide feed-back and updates pertaining to any and all coding or reviews.
8. Fulfill responsibilities and or duties that may be reasonably provided by Gonzaba Medical Group for the purpose of achieving operational or financial success of the Company.
9. Undergo quality, accuracy, and reliability testing and adhere to Company polices of such.
10. Make sure all codes meet all federal, state, legal and insurance regulations.
11. Reviews bulletins, newsletters, and periodicals, and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical record coding and documentation; develops and updates procedures manuals to maintain standards for correct coding, minimize the risk of fraud and abuse, and optimize revenue recovery.
12. Works collaboratively with clinical reviewers/auditors to identify HCC acuity diagnosis codes.
13. Provides queries or technical guidance to physicians, clinical staff, and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines data in the form of a query, email and or task.
14. Enhances professional growth and development through membership in professional organizations, participation at in-service meetings/educational programs, and department/ division performance improvement activities, and by referencing resource materials.
15. Maintain credentials and provide copies to your Supervisor/Lead and Human Resources.
16. Exercise tact and courtesy when dealing with patients, visitors, physicians, and co-workers.
17. Able to work efficiently under pressure.
18. Maintain strict confidentiality.
19. Other duties as assigned.
**Education and Experience:**
Minimum high school education or equivalent. Candidates must have Coding Certification by AHIMA (RHIA, RHIT, CCS, CCS-P or CCA) or AAPC (CPC, CRC) preferred. 3+ years experience in working with the Risk Adjustment (HCC) process preferred. Knowledge of ICD-10-CM, CPT, and HCPCS coding systems, guidelines, and rules. Knowledge of billing regulations, Managed Care insurance coverage limitations and protocols. Knowledge of medical terminology, medical procedures, human anatomy, and physiology. Knowledge of Word processing, database, spreadsheet, internet software and working with electronic medical record. Possess the ability to achieve and maintain the designated accuracy rate in coding while adhering to defined production standards. Demonstrate an increased proficiency in coding and encoder skills within three months. Strong interpersonal skills and detail oriented.
**Supervisory Responsibilities:** This job has no supervisory responsibilities.
**Work Environment:** Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
**Physical Demands:** Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. Close vision and ability to adjust focus.
**The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.**
**Skills**
**Education**
**Experience**
**Preferred**
**3 years:** Risk Adjustment (HCC)
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