Department: Health Services
Reports to: Supervisor, Risk Adjustment Coding
Location: 8735 Henderson Road Tampa FL 33634
WellCare has an immediate need for an experienced Risk Adjustment Coder to join our team!
PLEASE NOTE: This position allows for full time remote work AFTER the completion of 90 days AND meeting all assigned metrics/requirements for the role. Candidates will be required to work from work until both have been met.
Codes, abstracts and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Ninth Revision (ICD-9) for CMS risk adjustment purposes.
- 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
- 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. 2nd 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