Risk Adjustment Clinical Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA)
hace 6 días
Miami
City/State Doral, FL Work Shift First (Days) Overview: AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA in Doral, FL! Status: Full-timepermanent position (40 hours) Standard working hours: 8am to 430pm EST, M-F Location: This is a hybrid position, 2 days onsite in AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. Job Profile Summary Then Risk Adjustment Clinical Coder/Nurse 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. Education • Registered Nurse preferred 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)., • 2 years of medical coding experience. In lieu of associate's 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 medicais records REQUIRED AvMed is part of Sentara Healthcare, an integrated, not-for-profit health care delivery system celebrating more than 130 years of history with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division serving more than 1.2 million members in Virginia and Florida. 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! Talroo - Health Plan, Health Insurance, RN, Registered Nurse, Coding, CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA, CRC, ICD-10, Risk Adjustment, Florida, Doral, Centers for Medicare & Medicaid Services (CMS), U.S. Department of Health & Human Services (HHS), medical record reviews (MMR), Risk Adjustment Data Validation (RADV), 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), Registered Health Information Administrator (RHIA), AHA, HHS Hierarchical Condition Categories (HCC) Benefits: Caring For Your Family and Your Career Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000, • Paid Time Off and Sick Leave, • Paid Parental & Family Caregiver Leave, • Emergency Backup Care, • Long-Term, Short-Term Disability, and Critical Illness plans, • Life Insurance, • 401k/403B with Employer Match, • Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education, • Student Debt Pay Down - $10,000 In support of our mission "to improve health every day," this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.