This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Certified Risk Coder will be a part of an emerging coding team and coding service that performs retrospective and prospective risk coding reviews and completes provider training for a group of outpatient primary care practices across Massachusetts. This work ultimately leads to a greater understanding of the patient’s complexity while ensuring accurate risk adjustment for patient care. - Serves as an expert on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance and MassHealth Risk Adjustment guidance - Completes record review with a high degree of familiarity with common EHRs, especially Epic, NextGen, Centricity, and eCW - Assists in the compilation and delivery of project reports and facilitates provider-facing interactions - Completes internal audits per quality assurance protocols - Facilitates allowable modifications to the bill to ensure accuracy, involving extensive interaction with FQHC billing and operations staff departments - Assists in chart preparation for providers in advance of appointments - Communicates with provider education team on observed trends to improve documentation - Utilizes population health reporting tools to assist in the identification of patients and conditions in need of review and improvement - Identifies opportunities for FQHC risk score improvement - Performs other duties as assigned Qualifications - 0-5 years of risk coding experience - 0-5 years of medical billing experience in an outpatient setting, preferably in primary care, pediatrics, or behavioral health - Certified Risk Coding (CRC) Certification through AAPC required - In-depth knowledge of medical terminology, anatomy, physiology, and disease process - Knowledge of electronic health record systems: Epic, NextGen, Centricity, and eCW preferred - Expertise in Medicaid and/or Medicare risk adjustment models - Billing compliance expertise required - Self-starter; exercises high degree of initiative, judgement, discretion and decision making to achieve objectives - Familiarity with Excel - Performs with great integrity and produces accurate work with close attention to detail, especially in the completion of final deliverables to internal and external stakeholders Requirements - The Certified Risk Coder must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively as a member of an emerging team within a fast-paced organization. - Must communicate clearly and succinctly in writing and verbally across multiple tiers of the organization, from leadership to individual providers and health center staff. - Strong commitment to quality assurance and exceptional customer service. Desired Other Skills - Familiarity with the MassHealth ACO program - Familiarity with Federally Qualified Health Centers - Experience with anti-racism activities, and/or lived experience with racism is highly preferred Company Description Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

• Review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types. • Validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals. • Perform documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements. • Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types. • Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented. • Maintain strict patient and provider confidentiality in compliance with all HIPPA Guidelines. • Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.

• Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed • Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes • Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes • Using the Encoder software program, determines the codes for all diagnoses and procedures • Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies, etc. documented within patient records

• Reviews the content of the medical record for hospital and professional inpatient or outpatient records. • Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes and other ancillary services treatment records. • Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using procedure codes as required. • Using the Encoder software program, determines the codes for all diagnoses and procedures. • Determines their sequencing to legally maximize reimbursement. • Assigns the appropriate DRG. • Assigns codes based on hospital and professional coding guidelines, Coding Clinic directives, federal regulations, CCI coding initiatives, CPT Assistant or other standard coding guidelines. • Queries physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding. • Assists the Coding Quality and Professional Manager with training of new coding staff.