Job details

Risk Adjustment Coder

Porter is hiring a Risk Adjustment Coder to join our Team!

Porter combines the power of analytics with the power of care. Porter is a leading healthcare IT and services platform for care and coverage coordination that optimizes outcomes and member experience. We deliver understanding, compassion, information, and peace of mind for your members. Driven by robust AI analytics, Porter’s Care Guide team helps the member navigate the healthcare delivery system, secures the right support for each member’s specific needs, and directs Porter’s team of expert clinicians to perform comprehensive in-home assessments, complete with lab and diagnostic testing. By coordinating the complexities of each unique care journey, Porter helps close the gaps with the largest impact on quality measures, total cost of care, risk adjustment, and member experience.

Position Overview

We are seeking a certified coder with expertise in risk adjustment coding and a specialization in in-home health assessments. The ideal candidate will have a strong understanding of CMS risk adjustment and quality initiatives, exceptional attention to coding quality, and experience managing the provider query process. This role also requires the ability to handle multiple clients, each with unique coding requirements, while ensuring accuracy and compliance. Proficiency in utilizing coding clinics for provider education and feedback is essential. This role will be instrumental in ensuring the accuracy of coding and improving the efficiency of our assessment workflows. A key expectation is that the Risk Adjustment Coder will maintain 98% coding accuracy.

Key Responsibilities

Assign accurate ICD-10, CPT, and CPT II codes based on documentation from in-home assessments, ensuring compliance with CMS risk adjustment and quality guidelines.

Manage the provider query process to clarify documentation and ensure the completeness and accuracy of patient diagnoses, particularly related to chronic conditions.

Handle multiple clients with varying coding requirements, maintaining high standards of accuracy and adapting to specific client guidelines.

Utilize coding clinics and other reference materials to provide providers with targeted feedback and education on improving documentation and coding accuracy.

Conduct regular audits to monitor coding quality and adherence to internal and external standards.

Maintain a minimum of 98% coding accuracy to meet performance expectations and ensure compliance.

Stay current with coding standards, risk adjustment methodologies, and CMS regulatory changes to ensure ongoing compliance and optimal coding practices.

Collaborate with clinical teams to review documentation and provide insights on areas for improvement in coding and documentation.

Support coding education initiatives by creating and delivering training materials to providers, particularly focused on improving documentation practices.

Maintain confidentiality and ensure full compliance with HIPAA regulations.

Qualifications

Certification in medical coding (e.g., CPC, CRC) required.

Minimum 5 years of experience in risk adjustment coding, with specific experience in in-home assessments.

Expertise in managing provider queries and improving provider documentation through coding feedback.

Proficiency in using coding clinics and reference tools for accurate coding and provider education.

Strong knowledge of CMS risk adjustment and quality initiatives, including Hierarchical Condition Categories (HCCs).

Experience with electronic medical records (EMR) and coding tools.

Excellent communication skills, with the ability to collaborate with providers and clinical teams to drive coding improvements.

Strong attention to detail, prioritizing coding quality and compliance.

Preferred Qualifications

Experience in coding audits and providing actionable feedback to providers.