The Risk Adjustment PB Coder reviews, analyzes, validates and assigns codes from Mayo Clinic’s patient medical record for physician services in the outpatient or inpatient setting to include, but not limited to medical diagnosis, diagnostic, procedural services and E/M visits level coding information for various practices. A Risk Adjustment Coder is responsible for reviewing physician and other provider’s medical record notes and visit documentation to select or validate appropriate ICD-10-CM diagnosis codes as well as appropriate CPT-4 codes for CMS-1500 claim submissions. The primary focus of this role is diagnosis assignment related to risk adjustment payment methodology, which may influence provider cost and quality indicators.

Associate's Degree and 3 years of physician/professional coding experience required. 

Bachelor's Degree preferred in a health care related area. 

This position requires Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or coding credential of a Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) required upon hire and during tenure. 

Certified Risk Adjustment Coder (CRC) or Certified Clinical Documentation Specialist - Outpatient (CCDS-O) required within 3 years and thereafter.

Knowledge of professional/physician coding rules for inpatient, hospital outpatient, clinic, and/or emergency settings. Experience with or education of risk adjustment payment methodology, Hierarchical Condition Categories (HCCs), disease acuity, common diagnostics, treatment, pharmacology and Outpatient coding guidelines for official coding and reporting. In-depth knowledge of medical terminology, disease processes, patient health record content and the medical record coding process. Knowledge of principles, methods, and techniques related to compliant healthcare billing/collections. May need to be familiar with provider-based billing (PBB) and critical access hospital (CAH) coding and billing requirements.

*This position is a 100% remote work. Individual may live anywhere in the US.
**This vacancy is not eligible for sponsorship / we will not sponsor or transfer visas for this position.