Risk Adjustment Coder - Remote Work Opportunity

Pacific Medical Data Solutions, a company of LifePoint Health, is a rapidly growing nationwide revenue cycle management services provider that has been offering high quality medical billing services since 2004. We offer a rewarding work environment with career advancement opportunities while maintaining a small company, employee-focused atmosphere.

We are currently seeking a Risk Adjustment Coder for physician services. This remote-based position will bridge the gap between the providers, coders, and billers to clarify at-risk documentation to ensure accurate claim submission. You will be accountable for reviewing patient electronic medical records both prospective and retrospective submissions to validate an accurate representation of the severity of illness, risk adjustment ICD-10-CM /Hierarchical Condition Category (HCC) coding. Responsibility may include the ability to assign Current Procedural Terminology (CPT), Healthcare Common Procedure Coding Systems (HCPCS). You will make decisions on which codes and functions should be assigned in each instance.

This Position is 100% Remote; can work from anywhere within the US.

ESSENTIAL FUNCTIONS:  To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation. 

• Possess subject matter expert in how proper provider documentation drives accurate coding of outpatient services and associated risk adjustment.
• Demonstrate ability to build strong working relationships with Clinicians, Administrators, and Revenue Cycle colleagues.
• Leverage strong communication skills to bridge interrelated concepts, business functions, and processes to deliver results through an Outpatient CDI program.
• Understand various payment structures, fee schedules, and reimbursement methodologies in the outpatient setting and with physician encounters and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet reporting requirements.
• Deliver presentations educating physicians, group practices and administration.

KNOWLEDGE, SKILLS & ABILITIES: The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education:  This position requires a minimum of an Associate degree in a healthcare related program

Experience:  A minimum of 3 years of experience in health care, business, or finance

License or Certification:

This position requires an applicable CRC, credentialing through AHIMA, and/or AAPC with three years of ICD-10 and/or CPT/HCPCS coding. Certified Documentation Expert Outpatient (CDE-O) preferred or obtained within the first eighteen months of employment.

Skills and Abilities:

This position requires an understanding and knowledge of physician documentation requirements in a clinic setting to capture patients’ acute and chronic conditions

• ICD-10-CM Dx Coding experience
• Ability to work with physicians and providers
• Disciplined – ability to work on their own for the most part after training
• Knowledge/awareness of HCCs or risk models
• Ability to navigate in various electronic health records and utilize AI/NLP technologies
• Positive attitude and team player!

PHYSICAL AND MENTAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell.  The employee must occasionally lift and/or move up to 20 pounds.  Repetitive motion of upper body required for extended use of computer. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Benefits

At LifePoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

We also offer a flexible, remote work environment.

Pay range:  $27-31/hr, DOE The final agreed upon compensation is based on individual education, qualifications, experience, and work location. This position is bonus eligible.