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Medical Coding & Risk Adjustment Specialist
New York City or Remote
ABOUT US
Traditional health care is broken. Galileo is here to fix it. We’re a rapidly growing health startup that combines intuitive design and clinical expertise to deliver affordable, quality care for all.
Galileans, as we like to call ourselves, are dedicated to flipping the traditional health care model into a modern solution for todayand beyond. Our empathetic, mission-driven culture puts our patients first, celebrates creative problem solving, and moves quickly to build great products. Our teams work collaboratively, so there’s plenty of day-to-day interaction. We believe in a hybrid, flexible working environment and have team members across the U.S. and the UK.
ABOUT THE ROLE
Galileo is seeking an experienced Risk Adjustment Specialist to work within the Revenue Cycle team to oversee the review, documentation, and coding of medical claims. Your expertise in ICD-10-CM and select CPT code sets will support the providers in documenting visits and ensuring accurate reimbursement for all the services we provide. You’ll be responsible for accurate coding and documentation of care while building relationships with providers to create an efficient claims workflow.
Here’s what you’ll do:
- Code visits using ICD-10 and select CPT guidelines, ensuring all services are captured and the provider documentation supports all billed codes
- Query providers on documentation gaps ensuring documentation is complete and accurate
- Audit patient charts and claims for previously-billed services ensuring documentation is complete and coded accurately to the highest level of specificity following coding guidelines
- Work closely with providers and Director of Coding & Risk Adjustment to educate on coding and documentation best practices
- Report findings of chart audits and clinical documentation improvement (CDI) opportunities to providers to maximize the coding of ongoing risk-adjusted conditions
- Support an ongoing program that minimizes any organization risk of audit
- Remain current on coding guidelines and risk adjustment reimbursement reporting requirements
ABOUT YOU
We would love to hear from you if you have the following or equivalent experience:
- Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required (no CCA or CPC-A certifications will be considered for this role
- Certified Risk Adjustment Coder (CRC) a plus
- Requires the knowledge typically acquired over four or more years of work experience in risk adjustment
- Working knowledge of medical records and EHR systems
- Working knowledge of STARS and HEDIS measures
- Experienced in medical claims submission and billing process
- Working knowledge of medical terminology and disease processes as needed for chart reviews and documentation
- Strong clinical knowledge related to chronic illness diagnosis, treatment and management
- Strong written and verbal communications skills
COMPENSATION RANGE: $17.30 – $29.00 per hour based upon prior experience, performance, and market dynamics
BENEFITS
- Medical / Dental / Vision insurance
- Flexible Spending Account
- Health Savings Account + match
- Company paid STD/LTD, AD&D, and Life insurance
- Paid Family Leave
- 401K + match
- Paid Time Off