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Risk Adjustment Specialist - Certified Coder

Job Description | Triton Health Systems, LLC.


Date Prepared: 3/18/2010 12:00:00 AM Reports To: Manager of Risk Adjustment
Manager Approval: Department: Risk Adjustment
HR Review: Status: Exempt
Employee Signature: Revisions:
Job Summary This position is responsible for conducting chart audits in provider offices for the purpose of identifying and submitting documented diagnoses to the Centers for Medicare & Medicaid Services (CMS). Other responsibilities include working suspect reports to identify unreported diagnosis codes, requesting medical records from provider offices, scanning supporting documentation and identifying any other potential source of inaccurate payment. This position will also assist the Risk Adjustment Manager with working CMS transmission error reports and other risk adjustment projects as needed.
Essential Functions
  • Gain a thorough understanding of the risk-adjusted payment methodology, what can be submitted by the plan, and how/when submission impacts CMS payments.
  • Schedule appointments with provider offices and fax the chart pull listings to the offices well in advance of the visits.
  • Perform chart audits in physician offices by reviewing clinical documentation in the medical record against claims data.
  • Record findings completely and accurately using the risk adjustment software program.
  • Scan the supporting medical record documentation while onsite at the provider offices and then transfer the scanned images to the risk adjustment folder on the secure network
  • Assist the Risk Adjustment Manager with special projects as needed.
Qualifications • Certified Coder • 3 – 5 years of coding experience required (preferably hospital coding experience) • Requires reliable transportation and willingness to travel locally. Clean driving record and proof of automobile insurance required. • High school education, preferably two or more years of college • Excellent oral and written communication skills • Ability to work with minimal supervision • Excel experience
Physical Qualifications • Must be able to work under pressure from deadlines and goals. • Occasional lifting (< 25 lbs) • Must be able to drive to remote areas. • Must be able to read and interpret handwritten and typewritten material. • Must be able to sit for long periods of time (up to 8 hours) • Must be able to reach above and below the waist, turn, and twist
Additional Responsibilities Other duties as assigned. The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties, and tasks required of the individual as classified.


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