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Risk Adjustment Coder

Posted on Jun 14, 2019 by Wellcare

Tampa, FL 33634
Manufacturing
Immediate Start
Annual Salary
Full-Time

Location: Tampa, FL

Department: Health Services - RAPS
Report to: Sr. Manager, RAPS

Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9) for CMS risk adjustment purposes.
Essential Functions:
  • Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9). Always coding to the highest level of specificity.
  • Follows the Official ICD-9 guidelines for Coding and Reporting and has a complete understanding of these guidelines.
  • Follows CMS risk adjustment guidelines and has a complete understanding of these guidelines.
  • Understands the impact of ICD-9 codes on the CMS HCC risk adjustment model.
  • Ability to meet productivity and accuracy standards
  • Ability to defend coding decisions to both internal and external audits.
  • Other projects as necessary.

Education: High School Diploma, Associate's Degree preferred or equivalent work experience

Experience:

  • 2-4 years professional coding experience either in a hospital or physician setting
  • Expert knowledge of medical terminology and abbreviations and disease, illness and injury processes
  • Managed Care experience preferred
  • Working knowledge of CMS risk adjustment model preferred

Licenses/Certifications: CPC or CCS required

Special Skills (e.g. 2 nd language):

Must be able to effectively communicate verbally and in writing complex coding issues

Must be able to understand and follow verbal instructions and written polices and procedures to ensure adherence to standards and to instructions from management.

Must be able to read, write, speak, and understand English in order to communicate with customers, staff, vendors, and management.

Ability to work individually or as part of a team

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at . EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.

Reference: 720881917