Guidehouse HCC HEDIS Risk Adjustment Medical Coder- Remote in Boston, Massachusetts
Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
The HCC HEDIS Risk Adjustment Coder ensures the data integrity of coded patient records by reviewing the submitted medical documentation and validating that it accurately supports the assigned codes while following the Official Guidelines for Coding and Reporting, AHA coding clinics, CMS/MAC program guidance, internal policies and procedures and in accordance with all state and federal regulations. Ths is a 100% remote position.
The HCC HEDIS Risk Adjustment Coder will review clinical documentation and diagnostic results as appropriate to extract data and apply appropriate HCC related ICD-10 Diagnosis codes. Will have the ability to identify encounter level discrepancies and documentation improvement opportunities for provider education, as well as identifying and communicating trending issues. Will query providers regarding missing, unclear or conflicting documentation utilizing designated query process.
Must have a working knowledge of CPT/HCPCS codes as defined for the service type, for coding, billing, internal and external reporting, research and regulatory compliance. Under the direction of the coding manager—the coder should accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting, CMS/MAC rules and the CPT rules established by the AMA, and any other official coding guidelines established for use with mandated standard code sets. At times the coder scope may involve reviewing coding related denials from payers and recommending the appropriate action to resolve the claim based on payer guidelines.
3 years ICD-10 and CPT Coding Experience
3+ years HCC Risk Adjustment Coding experience
Experience working Physician Coding Related Denials, as applicable
HEDIS abstraction knowledge and experience preferred
Essential Job Functions
Proficiency and Understanding of CMS HCC Risk Adjustment Coding and data validation requirements.
Understanding of HHS Risk Adjustment Model
Good working knowledge of Anatomy and Physiology as well as Medical Terminology
Advanced knowledge of CMS/MAC guidance, Coding Skills, ICD-10-CM and CPT
Ability to analyze Provider documentation and assign codes accurately
Excellent verbal and written communication skills
Knowledge and application of government and other payer guidelines as they relate to compliant coding
High level of Accuracy and Productivity.
Ability to work independently
HIPAA compliant work stations
Strong working knowledge of Protected Health Information
Maintains professional credentials at all times
Strong knowledge of MS Office
Must be hold one of the following credentials: CPC, COC, CCS-P
Must have minimum three years of HCC risk adjustment coding experience.
Previous Epic or similar experience
Excellent verbal, written and interpersonal communication skills
Strong working knowledge and experience with federal and state coding regulations and guidelines
Advanced knowledge of Excel, Word and Powerpoint
Must be able to work independently, multi-task well and interface with all levels of personnel as well as clients
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
Candidates from Eastern Standard Time, Central Standard Time, and Pacific Standard Time Zones as well as candidates from Arizona, New Mexico and Utah will be considered for this position.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
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