Archcare Risk Adjustment Clinical Coder in New York, New York

Performance Management

The Risk Adjustment HCC Clinical Coder will report directly to the Risk Adjustment Manager & work directly with the Risk Adjustment HCC Clinical Coding Specialist. The Clinical Coder will perform accurate and timely coding review and validation of HCC’s through medical records. The Coder will document ICD-10-CM codes to verify that coding meets both established coding standards as well as CMS Risk Adjustment Guidelines. The Clinical Coder will assist the Risk Adjustment HCC Clinical Coding Specialist with projects assigned which will include develop coding related documentation policies specific to all Medicare & Medicaid Risk Adjustment criteria. Will also be responsible for timely completion of projects, including timeline development & maintenance as it pertains to encounter data.

Performance Management


Correct encounter rejects as pertaining to HCC coding issues. Verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on services rendered and document and present findings to Manager


Analysis to identify, collect, assess, monitor and document claims and encounter coding information as it pertains to Clinical Condition Categories.


Evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.


Other duties as assigned by superior.

Performance Management

Formal Education: High School Diploma or equivalent

Experience: 3 years

License, Registration, and / or Certification Requirement: Yes

Minimum Knowledge: Requires ability to interpret/extract information and/or perform arithmetic functions.

Language Ability: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Experience Requirements


Minimum of three (3) years with demonstrated sustained coding quality. Previous experience reviewing medical records for appropriateness code assignment. Knowledge of government claims processing methodology, ICD-10 and CPT coding guidelines and knowledge State and Federal regulations. Experience in HCC coding in a managed care setting General managed care system knowledge – claims, enrollment, provider, care management. General knowledge of state and federal regulatory requirements related to plan operations.

Experience Desired


Previous experience working in working in a managed care environment (Medicare / Medicaid)

License Requirements


Must be certified coded.

Skill Requirements


MS Office (MS Word, Excel and Access) skills are a must. Understanding of claims processing and how that impacts encounter files. Complete appropriate paperwork documentation system entry regarding claim encounter information. Demonstrate analytical and problem-solving ability regarding barriers to receiving and validating accurate HCC information.

Skill Desired


Knowledge of operations and regulations related to federal and state health plans – (Risk Scores, Claims)

ID: 2017-10501

Street: ArchCare Advantage

Shift Start Time: 9:00am

Shift End Time: 5:00pm

Hours: 35

External Company URL: http://www.archcare.org/