Certified Risk Adjustment Coder Senior

As Mount Sinai grows, so does our legacy in high-quality health care.

Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital, dedicated to continuing the training of the next generation of medical pioneers.

Culture of Caring: The Sinai Way

Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence.

Department:

CC019053 Population Health Clinical Ops

Job Description Summary:

Position Responsibilities

• Demonstrates knowledge of coding and documentation standards as well as CMS Risk Adjustment Program guidelines and HCCs (hierarchical condition categories).

• Reviews medical record to ensure all diagnosis codes are documented for the assignment of a valid and accurate HCC for each episode of care.

• Regularly reviews Epic HCC and payer reports.

• Queries and provides feedback and education to physicians when identifying documentation deficiencies to improve accuracy of risk adjustment coding.

• Demonstrates understanding of risk adjustment payment models.

• Uses clinical reasoning and critical thinking skills to discern the financial impact of a query in order to prioritize efforts most efficiently.

• Completes patient medical chart review upon visit completion by protocol, using the hospital resources (i.e. EPIC, Care Everywhere and Suspects reports provided by the Health plan).

• Performs coding and abstracting with an accuracy rate higher than 95%.

• Maintains log of activities as required for weekly and/or monthly reports (i.e. productivity and time management reports).

• Provides the primary source of data and information used in health care.

• Promotes provider/patient continuity, accurate database information, and the ability to optimize reimbursement.

• Maintains effective interpersonal skills and positive working relationship with co-workers and physicians.

• Promotes clear and accurate communications among the working team and with other related parties.

• Maintains information organized and ready for easy and quick access.

• Assists IMED physicians in understanding the CMS HCC Risk Adjustment Program as it relates to payment methodology and the importance of proper medical documentation of procedures and diagnosis coding.

• Assists providers and other professional staff in retrieving and compiling data for research, diagnosis, and teaching purposes.

• Utilizes analytics, identifies and target IMED physicians for Medicare Risk Adjustment training and documentation/coding resources.

• Other duties as assigned.

Qualifications

• License/Registration/Certification

  • CRC, CDEO, CPC, CPMA Certifications Required.

• Education

  • High school graduate.

• Experience

  • Five plus years’ experience in Coding and Billing, Knowledge of ICD-10-CM and CPT.

Benefits:

We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs:

• Health benefits
• Life insurance
• Long-term disability coverage
• Healthcare spending accounts
• Retirement plan
• Paid time off
• Pet Insurance
• Tuition reimbursement
• Employee assistance program
• Wellness program
• On-site housing for select positions and more!

Degree Requirements:

Certification: