Know ATS Score
CV/Résumé Score
  • Expertini Resume Scoring: Our Semantic Matching Algorithm evaluates your CV/Résumé before you apply for this job role: Risk Adjustment Coder.
United States Jobs Expertini

Urgent! Risk Adjustment Coder Job Opening In San Antonio – Now Hiring GONZABA MEDICAL GROUP



Job description

Description

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts.

It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation.

Supervisory Responsibilities: This position has no supervisory responsibilities.

General Requirements: 

All duties performed will be done accurately and in a timely manner.

  • Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
  • Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
  • Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
  • Participates in other Managed care projects to include but not limited to marketing events, and Medicare Open enrollment period.
  • Reviews reports to identify areas for improvement or needed action to meet departmental goals.
  • Supports team members in all aspects of the Risk Adjustment process to ensure that defined timelines and departmental goals are met.
  • Adhere to all confidentiality and HIPAA requirements as always outlined within Gonzaba Medical Group Operating Policies and Procedures in all ways and with respect to any aspect of the data handled or services rendered.
  • Other duties as assigned.
  • Essential Job Responsibilities:

  • Maintain compliance with Gonzaba Medical Group policies, Official Coding Guidelines and the Gonzaba Medical Group Coder’s Pledge.
  • Provides queries or technical guidance to physicians, clinical staff, and other departmental staff in identifying and resolving issues or errors, such as incomplete or missing records and documentation, ambiguous or nonspecific documentation, or codes that do not conform to approved coding principles/guidelines data in the form of a query, email and or task.
  • Accurately validate and abstract diagnosis codes from provider documentation in the patient medical record to ensure that reported ICD-10 codes are appropriately supported by the documentation.
  • Selects correct ICD-10-CM (diagnostic), CPT (procedural) and HCPCS codes based upon interpretation of office visit and other documentation, correct coding principles, and clinical validation with a focus on accurate capture of all supported HCC diagnosis codes.

    Remains up to date on all coding changes and usage.
  • Assesses qualifying notes for completion and/or identification of deficiencies; Communicates with provider/staff on elements to be addressed to ensure the note can be processed within the required timeline.
  • Performs review of Risk Adjustment audits for accuracy and for data entry into the EMR.
  • Utilizes nursing and coding knowledge to assist with review activities to support the Risk Adjustment process to include re-review of audit findings to ensure accuracy in documented HCC diagnoses and ICD-10 coding; review of various payer denial/rejection reports to identify areas for provider education.
  • Completes required electronic forms necessary for submission of applicable acuity diagnosis codes based on scheduled appointments.
  • Education and Training: Minimum high school education or equivalent required.

    An active Coding Certification by AHIMA (RHIA, RHIT, CCS, CCS-P or CCA) or AAPC (CPC, CRC) is required.

    Graduation from an approved practical nursing program and state-licensed practical nurse preferred.

    CPR with AED certification required.

    All certifications are required as initial and continued employment at Gonzaba Medical Group.

    Experience: 3+ years’ experience in working with the Risk Adjustment (HCC) process preferred.

    Knowledge of ICD-10-CM, CPT, and HCPCS coding systems, guidelines, and rules.

    Knowledge of billing regulations, Managed Care insurance coverage limitations and protocols.

    Knowledge of medical terminology, medical procedures, human anatomy, and physiology.

    Other Requirements: Computer Skills: Skilled in use of computer/EMR systems.

    Knowledge of Word processing software, spreadsheet software, Internet, and database software.

    Work Environment: Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment.

    Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

    Mental / Physical Requirements:  Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs.

    without assistance.

    Close vision and ability to adjust focus.

    Must be able to work efficiently under pressure.

    Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

    Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position.

    Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

    Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.

    Qualifications

    Skills

    Behaviors

    :

    Motivations

    :

    Education

    Required

    High School or better.

    Experience

    Preferred

    3 years:

    Experience in working with the Risk Adjustment (HCC) process.

    Licenses & Certifications

    Required

    CPR Certification

    Coding Cert AAPC

    Preferred

    LVN Certification


    Required Skill Profession

    Health Technologists And Technicians



    Your Complete Job Search Toolkit

    ✨ Smart • Intelligent • Private • Secure

    Start Using Our Tools

    Join thousands of professionals who've advanced their careers with our platform

    Rate or Report This Job
    If you feel this job is inaccurate or spam kindly report to us using below form.
    Please Note: This is NOT a job application form.


      Unlock Your Risk Adjustment Potential: Insight & Career Growth Guide


    • Real-time Risk Adjustment Jobs Trends in San Antonio, United States (Graphical Representation)

      Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for Risk Adjustment in San Antonio, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 12416 jobs in United States and 364 jobs in San Antonio. This comprehensive analysis highlights market share and opportunities for professionals in Risk Adjustment roles. These dynamic trends provide a better understanding of the job market landscape in these regions.

    • Are You Looking for Risk Adjustment Coder Job?

      Great news! is currently hiring and seeking a Risk Adjustment Coder to join their team. Feel free to download the job details.

      Wait no longer! Are you also interested in exploring similar jobs? Search now: .

    • The Work Culture

      An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at GONZABA MEDICAL GROUP adheres to the cultural norms as outlined by Expertini.

      The fundamental ethical values are:
      • 1. Independence
      • 2. Loyalty
      • 3. Impartiality
      • 4. Integrity
      • 5. Accountability
      • 6. Respect for human rights
      • 7. Obeying United States laws and regulations
    • What Is the Average Salary Range for Risk Adjustment Coder Positions?

      The average salary range for a varies, but the pay scale is rated "Standard" in San Antonio. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.

    • What Are the Key Qualifications for Risk Adjustment Coder?

      Key qualifications for Risk Adjustment Coder typically include Health Technologists And Technicians and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.

    • How Can I Improve My Chances of Getting Hired for Risk Adjustment Coder?

      To improve your chances of getting hired for Risk Adjustment Coder, consider enhancing your skills. Check your CV/Résumé Score with our free Tool. We have an in-built Resume Scoring tool that gives you the matching score for each job based on your CV/Résumé once it is uploaded. This can help you align your CV/Résumé according to the job requirements and enhance your skills if needed.

    • Interview Tips for Risk Adjustment Coder Job Success
      GONZABA MEDICAL GROUP interview tips for Risk Adjustment Coder

      Here are some tips to help you prepare for and ace your job interview:

      Before the Interview:
      • Research: Learn about the GONZABA MEDICAL GROUP's mission, values, products, and the specific job requirements and get further information about
      • Other Openings
      • Practice: Prepare answers to common interview questions and rehearse using the STAR method (Situation, Task, Action, Result) to showcase your skills and experiences.
      • Dress Professionally: Choose attire appropriate for the company culture.
      • Prepare Questions: Show your interest by having thoughtful questions for the interviewer.
      • Plan Your Commute: Allow ample time to arrive on time and avoid feeling rushed.
      During the Interview:
      • Be Punctual: Arrive on time to demonstrate professionalism and respect.
      • Make a Great First Impression: Greet the interviewer with a handshake, smile, and eye contact.
      • Confidence and Enthusiasm: Project a positive attitude and show your genuine interest in the opportunity.
      • Answer Thoughtfully: Listen carefully, take a moment to formulate clear and concise responses. Highlight relevant skills and experiences using the STAR method.
      • Ask Prepared Questions: Demonstrate curiosity and engagement with the role and company.
      • Follow Up: Send a thank-you email to the interviewer within 24 hours.
      Additional Tips:
      • Be Yourself: Let your personality shine through while maintaining professionalism.
      • Be Honest: Don't exaggerate your skills or experience.
      • Be Positive: Focus on your strengths and accomplishments.
      • Body Language: Maintain good posture, avoid fidgeting, and make eye contact.
      • Turn Off Phone: Avoid distractions during the interview.
      Final Thought:

      To prepare for your Risk Adjustment Coder interview at GONZABA MEDICAL GROUP, research the company, understand the job requirements, and practice common interview questions.

      Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the GONZABA MEDICAL GROUP's products or services and be prepared to discuss how you can contribute to their success.

      By following these tips, you can increase your chances of making a positive impression and landing the job!

    • How to Set Up Job Alerts for Risk Adjustment Coder Positions

      Setting up job alerts for Risk Adjustment Coder is easy with United States Jobs Expertini. Simply visit our job alerts page here, enter your preferred job title and location, and choose how often you want to receive notifications. You'll get the latest job openings sent directly to your email for FREE!