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Risk Adjustment Coder Job in Ventura, California

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Job Title: Risk Adjustment Coder

Employer:Clinicas del Camino Real, Inc.,
Required Certifications:RHIA,CRC (AAPC) or RHIT,CCS,CPC
Required Experience:3 to 4 years
Location: Ventura 93004, CA, US
Date Posted:12/11/2020

The Risk Adjustment Coder is responsible for the following:

  • Comply with organization’s policies and capable of following directions.
  • Prioritize tasks, collaborative work environment.
  • Performs an ongoing prospective and retrospective chart reviews.
  • Analyzes and deciphers clinical linguistics and medical terminologies to assign appropriate ICD-10 CM does.
  • Perform chart audits.
  • Identify trends in area of clinical documentation inconsistency, insufficiency and discrepancy.
  • Build a trustful rapport with providers.
  • Effectively communicate clarifications with providers through task query.  
  • Provider education on clinical documentation improvement efforts.
  • Attention to details impacts accuracy in data validation and quality data analysis.
  • Development of hierarchical condition category (HCC) tools and resource materials utilizing scientific evidenced-base medicine.
  • Compliance with CMS, OIG, The Joint Commission, and other government regulations and guidelines
  • Audits daily encounters to ensure clinical documentations are clear, consistent, concise and completed supported with the monitoring, evaluate, assessment and treatment (M.E.A.T.) or treatment, assessment, monitoring or medicate, plan, evaluate, and referral (T.A.M.P.E.R.™) components and data validation prior to claim submission.
  • Track HCC data validation.
  • Collaborate with multidisciplinary teams.
  • Quantitative analysis data-driven by HCC ICD-10 CM and HCC category count.
  • Quality analysis data-driven by HCC validation statuses where areas of improvements and opportunities can be identified. 
  • Ad Hoc Review.
  • Streamlining workflow processes and collaboration with multidisciplinary teams.
  • Other duties and tasks as assigned to identify continuous process improvement workflows.

Will perform other duties as assigned, including participation in all safety programs which may include assignment to an emergency team.

  • CPC, CRC (AAPC) or RHIT, RHIA, CCS (AHIMA) credentials required. Must maintain current credentials.
  • Minimum education: High School Diploma or equivalent. BS/BA preferred.
  • 2+ years of experience in Risk Adjustment required. 
  • Knowledge of medical terminology, anatomy and physiological, pathophysiological and pharmacological concepts.
  • Knowledge of ICD-10 coding conventions.
  • Comprehensive understanding of EHR contents.
  • Experience using software programs, Proficient in using MS Excel, PowerPoint and Word.
  • Experience in CMS Risk Adjustment Processing System (RAPS) and Risk Adjustment Data Validation (RADV) audits.
  • Familiar with Medicare Advantage Plans.
  • Analytics and problem-solving.
  • Apply critical thinking, utilize statistical functions, appropriate process improvement methodologies.
  • Excellent interpersonal skills and communicate professional amongst multidisciplinary teams.


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