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Risk Adjustment Coder

We are seeking an experienced Risk Adjustment Coder to join our growing team supporting our IRIS (Intus Revenue Integrity System) product. This role combines clinical knowledge, coding expertise, and analytical skills to ensure accurate diagnosis capture for our value-based care clients. 
 

What We Do:


Intus Care is a leading healthcare analytics platform dedicated to transforming care for PACE programs. By synthesizing complex healthcare data, we help identify risks, visualize trends, and optimize care delivery. Our platform empowers care providers to prevent high-risk events while equipping executives with the insights needed to make data-driven decisions based on comprehensive clinical and operational information. Our mission is to drive high-value, multidisciplinary care for older adults through actionable data.
 
In addition to our analytics solutions, we offer a range of consulting and technical support services for both new and established PACE programs as they grow and adapt to meet the needs of their communities.
 

In This Role You Will:

  • Perform comprehensive medical record reviews and risk adjustment coding using ICD-10-CM guidelines.

  • Validate diagnostic coding accuracy through natural language processing (NLP) assisted technology.

  • Review medical records to identify potential missed opportunities through a prospective review process.

  • Support real-time query processes to clarify diagnoses and identify high-risk conditions.

  • Contribute to quality assurance and compliance initiatives.

  • Collaborate with clinical teams to improve documentation practices.

  • Assist in developing and maintaining coding guidelines and protocols.

  • Participate in coding accuracy and consistency reviews.

  • Maintain a quality assurance score of 95% or above.

 

Required Qualifications:

  • Current CPC, CCS, or RHIT certification AND current CRC certification.

  • 5+ years of medical coding experience with risk adjustment coding background.

  • High School diploma required; Associate's or Bachelor's degree preferred.

  • Demonstrated experience working remotely and independently.

  • Strong understanding of healthcare regulations and risk adjustment requirements.

  • Clinical knowledge with proven ability to analyze medical record documentation.

  • Proficiency in applying coding conventions and official guidelines.

  • Must pass required coding examination.

  • Proficiency with electronic medical record systems.

  • Experience with coding and auditing software.

  • Strong computer skills and ability to learn new technologies.

  • Must reside in the United States of America.

Preferred Qualifications:

  • Additional certification in CPMA, CPCO, or CDEO.

  • Clinical documentation improvement experience.

  • Experience with Medicare Advantage or PACE programs. 

  • Background in quality assurance or compliance auditing.

 

Key Competencies:

  • Exceptional attention to detail and accuracy.

  • Strong analytical and problem-solving abilities.

  • Excellent written and verbal communication skills. 

  • Ability to work independently while contributing to team goals. 


What We Offer:

  • A chance to be a part of a trailblazing team in healthcare technology.

  • Competitive salary package.

  • Comprehensive benefits including health, dental, and vision insurance.

  • A collaborative, inclusive, and dynamic work environment.

  • Opportunities for professional growth and development.


Company Core Values:

  • Take Ownership for Your Responsibilities and Outcomes

  • Think With Data First

  • Be Passionate About Impact

  • Take Strides Toward Growth and Innovation

  • Be Supportive Of Each Other


Salary Range: $50,000-$70,000
Location: USA-based Remote

Intus Care is an equal opportunity employer and prohibits discrimination against persons of any kind on the basis of race, color, religion, gender, sexual orientation, nation of origin, age, disability, and genetics. 
 

Average salary estimate

$60000 / YEARLY (est.)
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$50000K
$70000K

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What You Should Know About Risk Adjustment Coder, Intus Care

Are you ready to take on a fulfilling role as a Risk Adjustment Coder with Intus Care? We’re looking for someone skilled in coding and clinical knowledge to join our passionate team supporting the IRIS (Intus Revenue Integrity System) product. This position merges your coding expertise with your analytical skills to ensure accurate diagnosis capture for our value-based care clients. At Intus Care, we are a pioneer in healthcare analytics, striving to enhance care for PACE programs through insightful data synthesis. As a Risk Adjustment Coder, you’ll be conducting thorough medical record reviews, validating diagnostic coding accuracy, and reviewing medical records for potential missed diagnoses. With a strong focus on improving documentation practices, you’ll collaborate with clinical teams, assist in maintaining coding guidelines, and prioritize quality assurance to uphold a remarkable accuracy score. To thrive in this role, you'll need a CPC, CCS, or RHIT certification alongside CRC certification and at least 5 years of experience in medical coding, specifically in risk adjustment. Your previous experience working independently and remotely will be vital as you navigate this critical position. If you’re driven by data, passionate about healthcare innovation, and eager to empower care providers with actionable insights, Intus Care is the place for you. Join our innovative team and help us deliver high-value care to older adults while enhancing your career path in a supportive and dynamic environment!

Frequently Asked Questions (FAQs) for Risk Adjustment Coder Role at Intus Care
What are the responsibilities of a Risk Adjustment Coder at Intus Care?

As a Risk Adjustment Coder at Intus Care, your responsibilities will include performing comprehensive medical record reviews, validating diagnostic coding accuracy using NLP technology, identifying missed opportunities through a prospective review process, and supporting real-time queries for high-risk conditions. You'll also participate in quality assurance initiatives and collaborate with clinical teams to enhance documentation practices.

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What qualifications do I need to become a Risk Adjustment Coder at Intus Care?

To qualify for the Risk Adjustment Coder position at Intus Care, you must have a current CPC, CCS, or RHIT certification along with a CRC certification. A minimum of 5 years of medical coding experience, particularly in risk adjustment, is essential. While a high school diploma is required, an Associate's or Bachelor's degree is preferred. Proficiency in coding conventions, electronic medical records, and coding software is also critical.

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Is remote work an option for the Risk Adjustment Coder role at Intus Care?

Yes, the Risk Adjustment Coder position at Intus Care is designed for remote work. Candidates should have demonstrated experience working independently in a remote setting, showcasing their ability to manage their responsibilities effectively while maintaining high standards of work.

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What is the salary range for a Risk Adjustment Coder at Intus Care?

The salary range for a Risk Adjustment Coder at Intus Care is between $50,000 and $70,000, depending on experience and qualifications. This competitive salary package reflects our commitment to attracting skilled professionals who are passionate about healthcare analytics.

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What core values does Intus Care uphold for its employees?

Intus Care is driven by core values that include taking ownership of responsibilities and outcomes, thinking with data first, being passionate about impact, promoting growth and innovation, and supporting one another. These values guide our approach to creating a positive and inclusive work environment for all employees.

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Common Interview Questions for Risk Adjustment Coder
What experience do you have with risk adjustment coding?

When answering this question, detail your past roles focusing on your coding experience, particularly in risk adjustment. Mention specific coding guidelines you've followed, any relevant certifications, and how you’ve utilized analytical skills in your evaluations.

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Can you explain your process for validating diagnostic coding accuracy?

To respond to this question, outline your systematic approach for validating coding accuracy, including how you would use medical records, coding conventions, and technology such as NLP tools. Specific examples can demonstrate your expertise.

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How do you ensure compliance with healthcare regulations in your coding work?

Discuss your understanding of relevant healthcare regulations and coding requirements. Elaborate on your strategies for staying current with changes in regulations and how you implement compliance in your daily coding tasks.

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Describe a time you identified a coding error. How did you handle it?

Use the STAR method (Situation, Task, Action, Result) to share a specific instance where you identified a coding error, explaining how you addressed it and what impact your actions had on the project or organization.

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How do you handle the pressure of meeting coding deadlines?

Share your time management techniques that help you stay organized and meet deadlines. Providing examples of past experiences where you managed workload and time effectively can reinforce your answer.

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What tools or software do you prefer for coding and auditing?

Discuss specific coding and auditing software you are proficient in, explaining their advantages. Highlight your adaptability to learn new technologies and how they help improve your coding accuracy and efficiency.

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How do you collaborate with clinical teams in your coding responsibilities?

Talk about your communication skills and how you interact with clinical teams to clarify diagnoses and improve documentation practices. Discuss the importance of teamwork in achieving quality outcomes.

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What is your approach to continuous improvement in coding practices?

Highlight your dedication to professional development, mentioning any courses or certifications you pursue. Discuss how you incorporate feedback and learning into your daily coding routines for constant improvement.

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What do you consider the most challenging aspect of risk adjustment coding?

Identify a specific challenge, such as keeping up with changing regulations or ensuring coding accuracy. Provide insights on how you manage this challenge through ongoing education, communication, and practice.

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Why do you want to work at Intus Care as a Risk Adjustment Coder?

Articulate your passion for healthcare and alignment with Intus Care’s mission of improving care through data analytics. Mention what attracts you to the company culture and how your values resonate with their core values.

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Full-time, remote
DATE POSTED
January 4, 2025

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