RN Risk Adjustment Coder
Responsible for performing audits of clinical records to ensure all assigned ICD-10 codes are appropriate, accurate,
and supported by the written clinical documentation in accordance with all state and federal regulations and internal
policies and procedures.
Qualifications and Experience:
- Current NYS RN License required.
- Bachelor’s degree in Nursing is preferred
- Sound knowledge of ICD-10 coding guidelines and regulations and MLTC Risk Adjustment Methodology is required, current AAPC or similar certification preferred.
- Minimum of 2 years recent and related experience in clinical record documentation review, diagnosis coding, and/or auditing. MLTC experience preferred.
- Strong verbal/written communication skills.
- Experience with Microsoft Office products (Word, Excel, and Power Point).
Essential Duties and Responsibilities:
- Reviews clinical records to ensure all assigned ICD-10 codes are accurate and supported by clinical documentation.
- Identifies and communicates documentation deficiencies to clinicians to improve documentation for accurate risk adjustment coding
- Provides position-specific training on ICD-10 coding and Risk Adjustment Methodology for staff members at the onset of the hiring process as well as on a continuous basis, creates training materials and presentations as needed.
- Effectively communicates the audit process and results to the appropriate departments and management.
- Assists senior level staff in providing recommendations for process improvement, so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved.
- Maintains current knowledge of ICD-10 codes, CMS documentation requirements, and state and federal regulations; maintains current AAPC/AHIMA certification if applicable.
- Participates in performance improvement activities, UAS reviews, clinical audits, team meetings, and orientation as requested.
- Demonstrates sound judgment by taking appropriate actions regarding suspected violation of corporate compliance regulations.
- Performs other duties as needed or assigned, travels to other Extended MLTC’s offices as needed.
The above statement reflect the general details considered necessary to describe the principal functions of the jobs as identified, and shall not be considered as detailed description of all work requirement that may be inherent in the position.