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Risk Adjustment Coder Professional Billing II, FT, Days, - Remote

Role overview

Qualifications

  • High School diploma or equivalent
  • Five (5) years professional fee coding experience
  • Certified Professional Coder (CPC)
  • Certified Risk Adjustment Coder (CRC)

Responsibilities

  • Conducts prospective review of charts to identify HCC opportunity
  • Conducts retrospective review of charts to confirm documentation supports reporting
  • Utilizes payor specific software to assist in capturing HCCs
  • Communicates with providers about HCC opportunities for improvement

About the company

Prisma Health logo

Prisma Health

Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. The company has one Purpose: Inspire health. Serve with compassion. Be the difference. Prisma Health is comprised of two affiliates: Prisma Health–Upstate and Prisma Health– Midlands. Together they are dedicated to improving the health of all South Carolinians through improved clinical quality, access to care and patient experience, while also addressing the rising cost of health care. The affiliates are nationally recognized as some of the best places to work and to receive care. With more than 30,000 team members, physicians and volunteers, Prisma Health is the state’s largest private employer. Prisma Health works to improve the health of the local communities in the Midlands and Upstate regions through its community health programs. As one of the 50 largest health systems in the country, Prisma Health is committed to academic and clinical research excellence and focuses on educating the next generation of physicians, nurses, dentists and other medical professionals. The Prisma Health executive home office is in Greenville, South Carolina. For more information, visit www.prismahealth.org. ALERT: We will never request personal information and/or money in exchange for an interview and we do not conduct interviews via Google Meet or Google Chat. There have been reports of malicious people posing as Prisma Health hiring managers and conducting interviews with candidates via Google Meet or Google Chat. This is a phishing scam that could result in them taking your identity and/or money. Our hiring managers and recruiters do not conduct interviews via Google Meet or Google Chat. If you are contacted by someone claiming to be a Prisma Health team member, and they ask you to interview via a Google app, end communication immediately and report the action to the police.

Company details

Company typeXLarge
Company size10001

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Job description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Conducts prospective review to abstract Hierarchical Condition Categories (HCC's) codes to report for the calendar year. Communicates (via Epic and in person) with providers on any outstanding HCC capture opportunities. Conducts retrospective reviews to ensure that documentation supports reporting the Hierarchical Condition Category code prior to payor submission.

Essential Functions

  • All team members are expected to be knowledgeable and compliant with Prisma Health's values:  Inspire health.  Serve with compassion.  Be the difference.

  • Conducts prospective review of charts to identify HCC opportunity.

  • Conducts retrospective review of charts to confirm documentation supports reporting.

  • Utilizes payor specific software to assist in capturing HCCs.

  • Communicates with providers about HCC opportunities for improvement.

  • Identifies suspect conditions that would potentially support reporting an HCC.

  • Participates in education offerings

  • Participates in monthly meetings

  • Performs other duties as assigned.

Supervisory/Management Responsibilities

  • This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

  • Education - High School diploma or equivalent or post-high school diploma / highest degree earned. Associate degree preferred

  • Experience - Five (5) years professional fee coding experience

In Lieu Of

  • NA

Required Certifications, Registrations, Licenses

  • Certified Professional Coder (CPC), and

  • Certified Risk Adjustment Coder (CRC)

Knowledge, Skills and Abilities

  • Knowledge of office equipment (fax/copier)

  • Proficient computer skills including word processing, spreadsheets, database

  • Data entry skills

  • Mathematical skills

Work Shift

Day (United States of America)

Location

Patewood Memorial Hospital

Facility

7002 Value-Based Care and Network Services

Department

70028459 HCC Coding Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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