Risk Adjustment Coding & Documentation Specialist
Company: Sentara Health
Location: Virginia Beach
Posted on: April 17, 2024
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Job Description:
City/State
Virginia Beach, VA
Overview
Work Shift
First (Days) (United States of America)
Sentara Medical Group is now hiring a Risk Adjustment Coding &
Documentation Specialist in Charlottesville, VA!
This is a full-time position, Monday-Friday, no nights, holidays,
or weekends.
This role consists of educating primary & specialty care providers
and staff on appropriate HCC coding & documentation, via virtual
sessions and in-person site visits. Duties include retrospective
auditing to ensure compliance with appropriate HCC coding &
documentation guidelines .
Candidate should be geographically located within the
Charlottesville/Blue Ridge area in order to visit practice sites
within the region.
Hybrid work model employed - office space available with
expectation 1-2 days/week in office; initial onboarding & training
will be in-office.
Previous HCC coding experience STRONGLY PREFERRED
Qualifications:
Benefits: Sentara offers an attractive array of full-time benefits
to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition
Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career
Advancement Opportunities, Work Perks, and more.
Our success is supported by a family-friendly culture that
encourages community involvement and creates unlimited
opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about
our People, Quality, Patient Safety, Service, and Integrity. Join a
team that has a mission to improve health every day and a vision to
be the healthcare choice of the communities that we serve!
Keywords: HCC Coding, Risk Adjustment, Monster, Talroo-Allied
Health, #Indeed
Job Summary
This role consists of educating primary & specialty care providers
and staff on appropriate HCC coding & documentation, via virtual
sessions and in-person site visits. Duties include retrospective
auditing to ensure compliance with appropriate HCC coding &
documentation guidelines . Candidate should be geographically
located within the Charlottesville area to be able to visit
practice sites within the area.
Candidate should be comfortable with Microsoft Office, including
PowerPoint & Excel and should be able to analyze performance data
to drive improvement plans.
Hybrid work model employed - office space available with
expectation 1-2 days/week in office; initial onboarding & training
will be in-office.
Performs compliance activities focused on risk adjustment in
accordance with Centers for Medicare & Medicaid Services (CMS) and
U.S. Department of Health & Human Services (HHS). Performs
prospective/retrospective medical record reviews (MMR) & CMS/HHS
Risk Adjustment Data Validation (RADV) audits. Reviews provider
coding for professional & inpatient/outpatient services to ensure
capture of diagnostic conditions supported within the provider's
documentation for CMS/HHS Hierarchical Condition Categories (HCC).
Supports risk adjustment data validation (RADV), medical record
retrieval, vendor coding audits, provider engagement, & all risk
adjustment ICD-10-CM coding-related activities. Conducts annual
risk assessments, training, monitoring, & auditing, control
assessment, reporting, investigation, root cause analysis, and
corrective action oversight. Performs vendor quality oversight
audits; reviews and/or makes final coding determination for
non-agreeable coding. Makes final decision on vendor-to-vendor
diagnosis coding rebuttal concerns. Serves as subject matter expert
on risk adjustment diagnosis coding guidelines. Coordinates risk
adjustment gap elimination with clinical and quality gap
elimination Maintains a reasonable fluency in workings & financial
implications of applicable risk adjustment models.
Associate degree required in healthcare administration, nursing,
health information management, accounting, finance, or other
related field with 2 years of medical coding experience. In lieu of
Associates degree, 4 years of medical coding experience required.
Must have thorough knowledge and understanding of ICD-10-CM
Official Coding Guidelines and AHA Coding Clinics. One-year
previous experience with paper and/or electronic medical records
required.
One of the following certifications are required: Certified
Professional Coder (CPC), Certified Outpatient Coder (COC),
Certified Inpatient Coder (CIC), Certified Coding
Specialist-Physician-based (CCS-P), Certified Coding Specialist
(CCS), Registered Health Information Technician (RHIT), or
Registered Health Information Administrator (RHIA).
Must obtain Certified Risk Adjustment Coder (CRC) certification
within two years of employment. Prefer one-year experience with
risk adjustment program in a Health Plan or Provider setting (i.e.
physician office or hospital). Prefer previous experience with CMS,
HHS and/or CDPS+RX Hierarchical Condition Categories (HCC) models.
Prefer previous CMS and/or HHS Risk Adjustment Data Validation
(RADV) experience.
Qualifications:
ALD - Associate's Level Degree
Certified Professional Coder (CPC) - Certification - American
Academy of Professional Coders (AAPC)
Coding, Medical Records Data
Skills
Active Learning, Active Listening, Communication, Coordination,
Critical Thinking, Judgment and Decision Making, Leadership,
Mathematics, Microsoft Excel, Microsoft Word, Monitoring, Reading
Comprehension, Service Orientation, Social Perceptiveness,
Speaking, Technology/Computer, Time Management, Troubleshooting,
Writing
Sentara Healthcare prides itself on the diversity and inclusiveness
of its close to an almost 30,000-member workforce. Diversity,
inclusion, and belonging is a guiding principle of the organization
to ensure its workforce reflects the communities it serves.
Per Clinical Laboratory Improvement Amendments (CLIA), some
clinical environments require proof of education; these regulations
are posted at ecfr.gov for further information. In an effort to
expedite this verification requirement, we encourage you to upload
your diploma or transcript at time of application.
In support of our mission to improve health every day, this is a
tobacco-free environment. Associated topics: actuarial, actuarial
assistant, actuarial consultant, actuarial director, actuary,
analyst, associate actuary, cost, life actuary, model
Keywords: Sentara Health, Virginia Beach , Risk Adjustment Coding & Documentation Specialist, Accounting, Auditing , Virginia Beach, Virginia
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here to apply!
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