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:
- Coding - 2 years Experience required.
- Medical Records Data - 1 year experience required.
- Associate's preferred but not required.
- Microsoft Office, including PowerPoint & Excel experience required. Should be able to analyze performance data to drive improvement plans.
- MUST be comfortable presenting to provider groups virtually and in-person.
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
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.