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ALTA IT Services is staffing a contract opportunity for a Medical Coding Specialist to support a leading health insurance customer. The HCC Coder working under the direction of the Manager of Risk Adjustment, determines the appropriate ICD-10 diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for Hierarchical Condition Categories (HCC). HCC Coding is a risk adjustment model designed to estimate future costs for patients. HCC coding relies on ICD-10-CM coding to assign risk scores to patients.

Pay $43/HR

100% Remote

Contract Position

Must have CRC Certificate or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required

Responsibilities:

• Review documentation available in the Medical Record to facilitate workflows that support the clinical documentation of illness and the patient care rendered to members.

• Reviews medical records for second pass and identifies potential deletes that vendor partnerships did not identify.

• Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs.

• Ensure documentation in the medical record follows the official coding guidelines that adheres to the business.

• Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities.

• Provide ongoing feedback and participate in education programs for physicians and other providers regarding coding guidelines and requirements.

  Qualifications

• Bachelors Degree or Equivalent work experience.

• 3+ years of working for a health plan, in a large provider practice or some combination of bother experiences.

• Knowledge of the Medicare, Commercial and Medicaid Risk Adjustment programs.

• Certified Risk Adjustment Coder Certification.

• Experience with electronic medical records.

• Ability to navigate member benefits across multiple product lines including Commercial, Medicaid and Medicare Advantage.

• Working knowledge of medical terminology, provider reimbursement, ICD-10, HCPCS and CPT-4 coding, coordination of benefits.

• Ability to handle multiple priorities and meet deadlines.

  #M2

System One, and its subsidiaries including Joulé, ALTA IT Services, CM Access, TPGS, and MOUNTAIN, LTD., are leaders in delivering workforce solutions and integrated services across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible full-time employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.