Risk Adjustment Coder

Employment Duration: 3 months

Location: Fully Remote

Openings: 2

The Health Information Coder I is an entry-level coder with a basic knowledge and skill set to utilize ICD-10-CM, CPT, and HCPCS classification systems to code across various healthcare settings, including outpatient, emergency department, and ancillary services.

This role ensures coding accuracy, compliance with regulatory guidelines, and adherence to UCSF policies, supporting proper reimbursement and revenue cycle integrity. The Coder I collaborates with healthcare providers, revenue cycle teams, and compliance departments to resolve documentation issues and maintain high standards of coding performance.

This position is hybrid and may require travel to UCSF Health for business purposes. The incumbent must be able to provide a safe and private home office environment for conducting UCSF business.

Key Responsibilities:

• Assign accurate ICD-10-CM, CPT, and HCPCS codes for diagnoses, procedures, and services based on documentation in the medical record, with a focus on ICD-10-CM codes that map to CMS-defined Hierarchical Condition Categories (HCCs).
• Ensure ICD-10-CM and CPT coding compliance with federal regulations, payer policies, UCSF standards (including UCSF HCC Coding Guidelines), and industry guidelines, including LCD/NCD requirements.
• Review medical records and abstract necessary information to ensure documentation supports assigned codes for billing and reimbursement.
• Identify and add ICD-10-CM diagnosis codes supported by clinical documentation, with a focus on codes that map to HCC categories.
• Resolve coding edits, discrepancies, and denials in collaboration with appropriate departments to ensure accurate claim submission.
• Maintain productivity and quality benchmarks, achieving organizational accuracy standards and ensuring timely completion of coding assignments.
• Participate in ongoing education and training to stay updated on changes in ICD-10-CM, CPT, HCPCS, regulatory compliance, and CMS-HCC Risk Adjustment models.
• Work with revenue cycle teams, providers, and compliance staff to clarify documentation and coding-related issues.
• Participate in special projects as directed, including data attestations in payor data systems, targeted reviews of provider documentation, and preparation of training materials.
• Use electronic medical records, coding software, and hospital billing systems to perform daily coding activities.
• Interact with internal and external UCSF Health staff and customers.
• Maintain satisfactory time and attendance.
• Demonstrate understanding of ICD-10-CM, CPT, and HCPCS coding classification systems, with a focus on diagnoses that map to CMS-HCC categories.
• Perform data searches and troubleshoot computer issues.
• Maintain patient confidentiality and IT security.
• Treat others with respect and work effectively as part of a team.
• Train others as requested.
• Follow safety and infection control guidelines.
• Maintain equipment and work area.
• Comply with the UCSF Health dress code.
Perform other duties as assigned.

The final salary and offer components are subject to additional approvals based on UC policy.

To see the salary range for this position (we recommend that you make a note of the job code and use that to look up): TCS Non-Academic Titles Search (https://tcs.ucop.edu/non-academic-titles)

Please note: An offer will take into consideration the experience of the final candidate AND the current salary level of individuals working at UCSF in a similar role.

For roles covered by a bargaining unit agreement, there will be specific rules about where a new hire would be placed on the range.

To learn more about the benefits of working at UCSF, including total compensation, please visit: https://ucnet.universityofcalifornia.edu/compensation-and-benefits/index.html