Risk Adjustment Clinical Coder

Archcare New York, NY

The Risk Adjustment HCC Clinical Coder will report directly to the Risk Adjustment Manager & work directly with the Risk Adjustment HCC Clinical Coding Specialist. The Clinical Coder will perform accurate and timely coding review and validation of HCC's through medical records. The Coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines. The Clinical Coder will assist the Risk Adjustment HCC Clinical Coding Specialist with projects assigned which will include develop coding related documentation/policies specific to all Medicare & Medicaid Risk Adjustment criteria.Will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter data.


Correct encounter rejects as pertaining to HCC coding issues

Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered

Document and present findings to Manager

Analysis to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories

Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives

Other duties as assigned by superior


MS Office (MS Word, Excel and Access) skills are a must

Understanding of claims processing and how that impacts encounter files

Complete appropriate paperwork/documentation/system entry regarding claim/encounter information

Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information

Minimum of three (3) years with demonstrated sustained coding quality

Previous experience reviewing medical records for appropriateness code assignment

Certified ICD-10 Clinical Coder