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Risk Adjustment Coder

Company: Renown Health
Location: Reno
Posted on: June 12, 2021

Job Description:

Renown Health

Position Description

Position Purpose:

The purpose of this position is to apply the appropriate diagnostic and procedure codes to individual patient health information for data retrieval, analysis, and claims processing for the health plan.

Nature and Scope:

Under the direction of the Risk Adjustment Supervisor, this position reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters covering a wide variety of clinical cases and services for risk adjustment models. This position is responsible for translating diagnostic phrases utilized by healthcare providers into coded form.

The incumbent must have the skill sets to:

  • Select correct ICD code assignment by proficient analysis and translation of diagnostic statements, physicians' orders, and other pertinent documentation.
  • Critically evaluate valid encounters, including face-to-face, legibility and valid signature, per Medicare, Commercial and Federal and State requirements
  • Maintain and grow the current knowledge of the Medicare and Commercial Risk Adjustment outpatient/inpatient billing systems/processes
  • Facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness
  • Stay current on all changes in coding conventions and coding updates
  • Conduct prospective and retrospective member reviews to close care gaps
  • Adhere to the coding guidelines
  • Work both in a team and individual environment with minimum supervision and is confident working with a wide variety of healthcare professionals
  • Consistently meet or exceed productivity and quality standards

The Incumbent must have a thorough understanding of the content of the medical record in order to be able to locate information to support or provide specificity for coding. The coder must be trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications: Requirements - Required and/or Preferred

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. Bachelor Degree in Health Information Management preferred.

Experience:

A minimum of one (1) year of previous coding experience required.

License(s):

None

Certification(s):

A current coding certification recognized by AAPC, AHIMA or other nationally recognized coding certification.

Computer / Typing:

Must possess, the computer skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc. Also, must have a working knowledge of Microsoft Office products.

Essential Physical Requirements

(The physical requirements section is used to identify the primary functions of the position for the purposes of determining Americans with Disabilities Act accommodations, Workers' Compensation return to work stipulations, ability to return to work following an accident or injury, etc. Please complete and check boxes as thoroughly and accurately as possible.)

It is common to encounter potential hazards in the healthcare environment. Some of these hazards could include, but are not limited to: radiation, toxic chemicals, biological hazards, heat, cold, noise, dust and stress. Renown Health has a Safety Management program in place addressing these issues.

Physical Activity

Percentage of time (equaling 100%) during the normal workday the employee is required to:

Sit:

70%

Stand:

10%

Walk:

10%

Run:

Squat:

2%

Bend:

2%

Twist:

2%

Lift:

2%

Kneel:

2%

Drive:

Climb:

Crawl:

Reach above shoulder:

Other:

Tools and/or Equipment:

Frequency

Occasional (01-33%)

Frequent (34-66%)

Continuous

(67-100%)

Computers

X

Telephone

X

Copier and facsimile

X

Rolling or open files

X

Repetitive Use of Hands and Feet:

Not Required

Occasional

(01-33%)

Frequent

(34-66%)

Continuous

(67-100%)

Simple Grasping

X

Pushing / Pulling

X

Typing / Data Entry

X

Fine Manipulation

X

Lifting and Carrying:

Weight to be manually lifted each normal workday. (Occasional 1 - 33%, Frequent 34 - 66%, Continuous 67 - 100%)

Not Required

Occasional

Frequent

Continuous

Up to 10 lbs

X

Up to 20 lbs

X

Up to 35 lbs

X

Up to 50 lbs

X

Up to 75 lbs

X

Up to 100 lbs

X

Over 100 lbs

X

Sensory Requirements:

Essential Functions

The ability to take and follow direction as tasks are assigned.

The ability to come to work promptly and routinely.

Keywords: Renown Health, Reno , Risk Adjustment Coder, Other , Reno, Nevada

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