• Clinical Coder & Data Entry Coordinator

    Location US-NY-New York
    Posted Date 1 month ago(9/10/2018 2:26 PM)
    Job ID
    # Positions
    ArchCare Community Services
    Experience (Years)
    Work Days Per Week
    Shift Start Time
    Shift End Time
    # Hours
  • Overview

    The Clinical Coder & Data Entry Coordinator will report directly to the Risk Adjustment Manager & work directly with the Risk Adjustment Lead HCC Clinical Coder.  The Clinical Coder will perform accurate and timely coding review and validation of HCC’s through medical records.  The Coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines.  Once the ICD-10 codes have been documented data entry will be required to submit claims to the plans 3rd party administrator claims system for adjudication of that claim.  The Clinical Coder will assist the Risk Adjustment Lead HCC Clinical Coder with projects assigned which will include develop coding related documentation/policies specific to all Medicare & Medicaid Risk Adjustment criteria.    

    Will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter data.



    Correct encounter rejects as pertaining to HCC coding issues

    Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered

    Document and present findings to Manager

    Analysis to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories

    Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives

    Other duties as assigned by superior


    Must be a certified coder CPC, CCS, CCS-P or other Allied Health credentials & a minimum of three (3) years with demonstrated sustained coding quality

    Previous experience reviewing medical records for appropriateness code assignment

    Knowledge of ICD-10 and CPT coding guidelines and knowledge State and Federal regulations

    Experience in HCC coding in a managed care setting


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