Medical Coder - Risk Adjustment Job at Cambia Health Solutions, Inc, Portland, OR

  • Cambia Health Solutions, Inc
  • Portland, OR

Job Description

Medical Coder - Risk Adjustment (Risk Adjustment Auditor II)

Work from home within Oregon, Washington, Idaho or Utah

Build a career with purpose. Join our to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia's dedicated team of Medical Coders - Risk Adjustment (Risk Adjustment Auditor II) is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Medical Coders performs Retrospective/Prospective chart review both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting. Identifies trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies - all in service of creating a person-focused health care experience.

Do you thrive as part of a collaborative, caring team?] Then this role may be the perfect fit.

What You Bring to Cambia:


Medical Coder - Risk Adjustment (Risk Adjustment Auditor II) would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required. Risk Adjustment, HCC or Inpatient coding experience preferred.

Skills and Attributes:

  • Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.

  • Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.

  • Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.

  • Demonstrated ability to identify and communicate trends in provider coding and documentation.

  • Effective verbal and written communication skills.

What You Will Do at Cambia:

  • Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.

  • Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.

  • Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.

  • Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.

  • Supports and actively participates in process and quality improvement initiatives.

  • Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.

  • Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program. Assists with implementation activities as a result of regulatory changes to the Program.

The expected hiring range for a Medical Coder - Risk Adjustment (Risk Adjustment Auditor II) is $68,000.00 - $92,000.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%. The current full salary range for this role is $64,000.00 to $104,000.00.


Job Tags

Work from home,

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