Job Description

Job Summary

As an MRA Comprehensive Review Coder, you will play a vital role in ensuring accurate and complete medical documentation coding for Medicare Risk Adjustment (MRA) purposes. Your primary responsibility will be reviewing medical records, extracting relevant information, and assigning appropriate diagnosis codes following established guidelines. Your coding expertise will directly impact the accuracy of risk adjustment data, which is crucial for proper reimbursement and quality reporting. Attention to detail, proficiency in coding systems, and adherence to compliance regulations are essential for success in this role.

Job Responsibilities:

• Review and analyze medical records to identify diagnoses, procedures, and relevant clinical information necessary for MRA coding.
• Complete a sample audit of progress notes, populate information in Excel spreadsheet and provide feedback to physician regarding the documentation and coding guidelines.  
• Assign appropriate ICD-10-CM diagnosis codes to accurately reflect the patient's medical conditions and ensure compliance with coding guidelines and regulations.
• Ensure that coding is consistent with the clinical documentation and accurately reflects the severity of illness and risk of the patient.
• Collaborate with physicians, clinicians, and other healthcare professionals to clarify documentation and gather additional information, when necessary, to ensure accurate coding.
• Utilize electronic health record (EHR) systems and coding software to facilitate the coding process and maintain accurate records.
• Stay updated with the latest coding guidelines, regulations, and industry best practices to ensure compliance and accuracy in coding assignments.
• Assist in the development and implementation of coding policies and procedures to optimize coding efficiency and accuracy.
• Conduct periodic quality audits to assess the accuracy and completeness of coded data, identifying areas for improvement and providing feedback to coding team members, as needed.
• Maintain confidentiality and adhere to HIPAA regulations when handling sensitive patient information.
• Collaborate with interdisciplinary teams, including coding managers, auditors, and revenue cycle professionals, to address coding-related issues and contribute to the overall revenue cycle management process.

Job Qualifications:

• High school diploma or equivalent; a degree or certification in Health Information Management, Medical Coding, or a related field is preferred.
• 3 years of working as a certified medical coder.
• Coding certification through AHIMA / AAPC is  required  
• Excel experience required  
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential is highly desirable.
• Proven experience in medical coding, specifically in risk adjustment coding and comprehensive review.
• Proficient knowledge of ICD-10-CM coding guidelines and familiarity with Hierarchical Condition Categories (HCCs) and Risk Adjustment Factor (RAF) scoring methodologies.
• Strong understanding of medical terminology, anatomy, and physiology.
• Familiarity with various healthcare settings, including hospitals, clinics, and physician practices.
• Proficiency in using coding software and electronic health record (EHR) systems.
• Excellent attention to detail and accuracy in coding assignments.
• Strong analytical and problem-solving skills.
• Ability to work independently and efficiently manage time to meet coding deadlines.
• Excellent communication skills to collaborate effectively with healthcare professionals and coding team members.
• Knowledge of healthcare compliance regulations, including HIPAA and CMS guidelines.
• Ability to adapt to changing coding guidelines and stay updated with industry changes and best practices.

This job description outlines the general responsibilities and requirements for the role of an MRA Comprehensive Review Coder. It may be modified and adjusted according to the specific needs and requirements of the hiring organization.

BENEFITS

• Comprehensive benefits package, including Health, Vision, Dental, and Life insurances
  • FSA and Life Assistance Program (EAP)
  • 401(k) Retirement Plan
  • Health Advocacy, Travel Assistance, and My Secure Advantage
• PTO Accrual and Holidays

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