Loma Linda University Health
Department:
UHC: Managed Care-LLUHC/41077
Job Summary:
The Coder 1 * Risk Adjustment is responsible for clinical documentation review related to Risk Adjustment Data Validation (RADV) timelines, focusing on completeness and accuracy of provider documentation concerning severity of illness and supporting clinical care plans for Hierarchical Condition Category (HCC) diagnoses. Initiates communication with providers to clarify documentation needs and provides education on documentation integrity, completeness, and compliance with guidelines from CMS, ICD-10-CM, AHA Coding, and health plans. Performs other duties as needed.
Education and Experience:
Bachelor's degree in Health Information Management or a related healthcare field preferred; equivalent education and experience may be considered. Requires 2+ years of clinical/medical experience, including at least 1+ year of Risk Adjustment coding or Clinical Documentation Improvement experience.
Knowledge and Skills:
Understanding of electronic medical records, medical terminology, ICD-10-CM coding, and CMS RADV for Medicare Advantage Plans. Proficiency in medical coding (E/M, ICD-10, CPT, HCC) preferred. Ability to keyboard 40 wpm, communicate effectively in English, operate office equipment, and collaborate professionally. Must have strong organizational skills, attention to detail, critical thinking, and the ability to work independently and under pressure.
Licensures and Certifications:
Certified Risk Adjustment Coder (CRC) required; Certified Clinical Documentation Specialist (CCDS) preferred. Equivalent work experience and certifications from AAPC or AHIMA may substitute for specific certifications.
#J-18808-Ljbffr
UHC: Managed Care-LLUHC/41077
Job Summary:
The Coder 1 * Risk Adjustment is responsible for clinical documentation review related to Risk Adjustment Data Validation (RADV) timelines, focusing on completeness and accuracy of provider documentation concerning severity of illness and supporting clinical care plans for Hierarchical Condition Category (HCC) diagnoses. Initiates communication with providers to clarify documentation needs and provides education on documentation integrity, completeness, and compliance with guidelines from CMS, ICD-10-CM, AHA Coding, and health plans. Performs other duties as needed.
Education and Experience:
Bachelor's degree in Health Information Management or a related healthcare field preferred; equivalent education and experience may be considered. Requires 2+ years of clinical/medical experience, including at least 1+ year of Risk Adjustment coding or Clinical Documentation Improvement experience.
Knowledge and Skills:
Understanding of electronic medical records, medical terminology, ICD-10-CM coding, and CMS RADV for Medicare Advantage Plans. Proficiency in medical coding (E/M, ICD-10, CPT, HCC) preferred. Ability to keyboard 40 wpm, communicate effectively in English, operate office equipment, and collaborate professionally. Must have strong organizational skills, attention to detail, critical thinking, and the ability to work independently and under pressure.
Licensures and Certifications:
Certified Risk Adjustment Coder (CRC) required; Certified Clinical Documentation Specialist (CCDS) preferred. Equivalent work experience and certifications from AAPC or AHIMA may substitute for specific certifications.
#J-18808-Ljbffr