Risk Adjustment Coder - Veradigm
Raleigh, NC
About the Job
Welcome to Veradigm, where our Mission is transforming health, insightfully. Join the Veradigm team and help solve many of today's healthcare challenges being addressed by biopharma, health plans, healthcare providers, health technology partners, and the patients they serve. At Veradigm, our primary focus is on harnessing the power of research, analytics, and artificial intelligence (AI) to develop scalable data-driven solutions that bring significant value to all healthcare stakeholders. Together, we can transform healthcare and enable smarter care for millions of people.
Veradigm Payer
Veradigm understands that managed care organizations, pharmacy benefit managers (PBMs), insurance companies, health plans, and other payers need to balance controlling costs with the goal of providing the highest quality of care and optimizing health outcomes for their members.
Solutions from Veradigm Payers:
- Deliver insights to drive quality outcomes cost-effectively
- Improve efficiency for themselves, their providers, and their members through high-speed clinical data exchange
- Impact point-of-care decision making positively by integrating payer guidance and prior authorization management directly in each healthcare provider's existing workflow
Job Summary
Analyzes and translates concurrent, prospective, and retrospective medical and clinical diagnoses, procedures, injuries, and illnesses into Medicare Risk Adjustment (MRA) ICD-10 codes and Hierarchical Condition Categories (HCCs). Completes assignments with an emphasis on completeness, accuracy, and supporting clinical care plans as it pertains to Risk Adjustment Data Validation (RADV) timelines.
Essential Functions
- Accurately validates and abstracts diagnosis codes from provider documentation in medical records.
- Analyzes and translates moderately complex medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes, adhering to the CMS Risk Adjustment Models.
- Conducts peer quality reviews to identify incorrect coding, providing feedback and education on audit results.
- Monitors HCC coding performed by outside vendors by performing quality audits to ensure accuracy.
- Exhibits and utilizes a full understanding of current client coding guidelines and relevant federal regulations using current ICD-10-CM materials, the Federal Register, and other pertinent materials.
- Ensures compliance with all applicable federal, state, and local regulations, as well as with institutional/organizational standards, practices, policies & procedures.
- Works on Special Projects.
- Demonstrates analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.
- Maintain 95% quality, accuracy, and completeness.
Job Requirements
- High School Diploma or GED (Required)
- 2-4 years relevant work experience (Preferred)
- AAPC or AHIMA Certification (CPC, CRC, CCS) (Required)
- Certified Risk Adjustment Coder (Preferred)
Location
- Remote
Knowledge, Skills and Abilities
- Knowledgeable of medical and clinical terminology, disease processes, and pharmacology.
- ICD-10-CM proficient
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Enhancing Lives and Building Careers
Veradigm believes in empowering our associates with the tools and flexibility to bring the best version of themselves to work and to further their professional development. Together, we are In the Network. Interested in learning more?
Take a look at our Culture, Benefits, Early Talent Program, and Additional Openings.
We strongly advocate that our associates receive all CDC recommended vaccinations in prevention of COVID-19.
Visa Sponsorship is not offered for this position.
At Veradigm, our greatest strength comes from bringing together talented people with diverse perspectives to support the needs of healthcare providers, life science companies, health plans, and the patients they serve. The Veradigm Network is a dynamic, open community of solutions, external partners, and cutting-edge artificial intelligence technologies that provide advanced insights, technology, and data-driven solutions. Veradigm offers a comprehensive compensation and benefits package, including holidays, vacation, medical, dental, and vision insurance, company paid life insurance and retirement savings.
Veradigm's policy is to provide equal employment opportunity and affirmative action in all of its employment practices without regard to race, color, religion, sex, national origin, ancestry, marital status, protected veteran status, age, individuals with disabilities, sexual orientation or gender identity or expression or any other legally protected category. Applicants for North American based positions with Veradigm must be legally authorized to work in the United States or Canada. Verification of employment eligibility will be required as a condition of hire. Veradigm is proud to be an equal opportunity workplace dedicated to pursuing and hiring a diverse and inclusive workforce.
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