Executive / Officer - Industrial Engineering (Word Study)
Jafferjee Brothers Exports (Pvt) Ltd
The risk adjustment coder is responsible for developing and maintaining medical record coding and auditing functions within the risk adjustment team.
Duties and responsibilities
Provides quality oversight of the medical record review process to ensure the accuracy of the codes being both submitted and retracted by both internal coding functions and by external coding vendors
Develops and maintains an auditing dashboard to communicate the results of the audits and findings to internal and external stakeholders
Uses information collected during audits to develop training and feedback initiatives for the hoa provider network
Works directly with provider offices on a regular basis
Coordinates all risk adjustment data validation (radv) audits and reviews and submits all requested material
Collects all required materials from internal hoa systems as well as provider offices
Develops and maintains a radv database to store medical records that have been deemed “best medical record” for easy retrieval during radv audits
Keeps informed of changes to the risk adjustment process and participates and/or directs research of special projects relevant to risk adjustment changes
Develops audit processes and standard operating procedures that govern the risk adjustment team’s regulatory obligations around radv audits, and submission of supplemental diagnosis codes
Regular and predictable attendance
Consistently demonstrates compliance with hipaa regulations, professional conduct, and ethical practice
Maintains work area in a clean and orderly condition and ensures safe operating conditions within area of responsibility
Works to encourage and promote company culture throughout the organization
Other duties as may be assigned
Associates degree or higher and at least two years coding experience in a managed care or primary care setting, or an equivalent combination of education
Experience with risk adjustment models and methodology
Certified professional coder
Certified risk adjustment coder or equivalent risk adjustment coding experience
Demonstrated experience with icd, cpt, drg, and hcpcs coding systems
Skilled in data collection, analysis and data presentation methods
Skilled with microsoft office suite (word, excel, powerpoint, access)
Excellent verbal, written, presentation and process/project management skills
Problem resolution skills
Ability to adjust to multiple demands & shifting priorities
Self-directed; able to work alone
Possess a valid driver's license
Ethics - honest, accountable, maintains confidentiality
Reliability - the extent to which the employee can be depended upon to be available for work, do it properly, and complete it on timeThe degree to which the employee is reliable, trustworthy, and persistent.
Sense of urgency - meets deadlines, establishes appropriate priority, gets the job done in a timely manner
Computer skills - skilled with computers, takes advantage of new technology, learns new tools quickly, uses technology to enhance job performance
Decision making - able to reach decisions, takes thoughtful approach when considering options, seeks input from others, makes difficult decisions
Dependability - completes job assignment and projects with minimal supervisionMeets schedules and deadlines.
Initiative - takes action, seeks new opportunities, strives to see projects to completion
Job knowledge - knowledge of products, policies and procedures; or knowledge of techniques, skills, equipment, procedures, and materials.
Planning & organizing - displays ability to effectively plan, organize and implement applicable tasks or projects in relation to established goals and objectives.
Quality - strives to eliminate errors, accurate work is a priority, seeks opportunities to improve product/services
Physical, mental, environmental & working conditions
Moderate amount of walking, sitting, and writingModerate to significant amount of stress in meeting deadlines and dealing with day-to-day events in the execution of job dutiesNeeds flexibility and adaptability to changeCandidate must be self-disciplined and a self-starter and able to work independently with a flexible work scheduleMust be able to drive a vehicle and daytime/overnight travel as required.