Risk Adjustment Coder | USRN
2 weeks ago
Role
Risk Adjustment Coder | USRN - UM Reviewer at UST
Location: Taguig, National Capital Region, Philippines
Responsibilities- Assign appropriate ICD-10-CM codes, mapping to risk adjustment models for Medicare Advantage and ACA Commercial Projects.
- Assign Flag events and CDI for documentation discrepancies.
- Comply with the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines.
- Comply with HIPAA laws and regulations.
- Maintain quality (≥97%) and production standards.
- Remain current on diagnosis and coding guidelines and risk adjustment reimbursement reporting requirements.
- Utilization Review
- At least 2+ years of medical coding experience (HCC Risk Adjustment)
- USRN – Active license
- Experienced Utilization Management Reviewer
- Experienced in the application of guidelines and processes in UM Reviews
- Active coding certification under AAPC or AHIMA; Certified Risk Adjustment Coding (CRC) certification preferred
- Able to code using ICD-10-CM physical codebook or coding software
- Strong clinical knowledge related to chronic illness diagnosis, treatment, and management
- Proficient in using computers, including MS Office and internet applications
- Night shift is mandatory
- This is a full-time, in-office role with 5 working days per week
- Candidates must demonstrate alignment with UST’s core values: Humility, Humanity, and Integrity
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