Risk Adjustment Coder

4 days ago

Manila, National Capital Region, Philippines UST USource Full time $40,000 - $80,000 per year
  • 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

Additional Requirements:

  • 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

Qualifications:

  • 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

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