Advocate Health is hiring a Coder III - Risk Adjustment for a remote, full-time position. In this role, you will be a subject matter expert, reviewing complex medical documentation to assign accurate diagnosis and procedure codes, ensuring compliance with federal and insurance regulations. You will also contribute to training, special projects, and maintaining high departmental standards.
What You'll Do
- Review complex medical documentation to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS.
- Ensure correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations.
- Serve as a subject matter expert in assigned specialty and actively participate in Coding meetings as a problem solver.
- Assist with special projects and training other coders as requested.
- Monitor and respond to accounts in the charge router, charge router messages, CRMs, and Compliance and Integrity review requests.
- Follow up and obtain clarification of inaccurate documentation as appropriate.
- Maintain continuing education by attending webinars and reviewing updated coding guidelines.
- Abide by the Standards of Ethical Coding as set forth by AHIMA and adhere to official coding guidelines.
- Maintain the confidentiality of patient records and report any perceived non-compliant practices.
- Meet and exceed departmental quality (95% or more) and productivity standards (100%).
- Assist in the production of annual edit review based on CPT, ICD and HCPCS changes.
- Answer and prioritize correspondence at all levels.
- Perform any other assigned duties.
What We're Looking For
- Coding Certification issued by AAPC or AHIMA.
- Advanced training beyond High School in Medical Coding or related field (or equivalent knowledge).
- Typically requires 5 years of experience in professional coding.
- Experience must include professional revenue cycle processes and health information workflows.
- Proficient in Microsoft Office, Word, Excel, and PowerPoint.
- Advanced knowledge of anatomy, physiology, medical terminology, pathophysiology, and pharmacology.
- Demonstrates knowledge of NCCI edits, and local and national coverage decisions.
- Expert knowledge and experience in ICD-10-CM, CPT, and 3M Encoder.
- Expert knowledge and experience in ICD-10-CM and CPT coding systems, G-codes, HCPCS codes, modifiers, and APCs.
- Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
- Expert knowledge of coding workflow and optimization of technology.
- Excellent communication and reading comprehension skills.
- Demonstrated analytical aptitude, with a high attention to detail and accuracy.
- Experienced with remote workforce operations.
- Strong sense of ethics.
Technical Stack
- ICD-10-CM/PCS
- CPT
- HCPCS
- 3M Encoder
- Microsoft Office Suite
- EMR and/or Computer Assisted Coding software
Team & Environment
This role reports to a coding leader or supervisor as part of a collaborative coding team.
Benefits & Compensation
- Compensation: $28.05 - $42.10 per hour
- Paid Time Off programs
- Health and welfare benefits (medical, dental, vision, life, Short- and Long-Term Disability)
- Flexible Spending Accounts
- Family benefits (adoption assistance, paid parental leave)
- Defined contribution retirement plans with employer match
- Educational Assistance Program
- Opportunity for annual increases based on performance
- Premium pay for shifts, on call, etc.
Work Mode
This is a fully remote, full-time position.
Advocate Health is an equal opportunity employer.
