Risk Adjustment Coding & Documentation Specialist - Pace

City/State

Norfolk, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara PACE is now hiring a Risk Adjustment Coding & Documentation Specialist in Hampton Roads.

Shift: Mon

• Fri (8am

• 5pm) / No Holidays or Weekends

Location: Sentara PACE Norfolk and Portsmouth locations

This role consists of educating PACE 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 .

Previous HCC coding experience STRONGLY PREFERRED

Qualifications:

• Medical Records Data

• 1 year experience required.

• 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.

• 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 have thorough knowledge and understanding of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics.

• 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.

• 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, Coding, Claims

Job Summary

This role consists of auditing & educating PACE providers and staff on appropriate HCC coding & documentation. Duties include prospective and concurrent auditing to ensure compliance with appropriate HCC coding & documentation and submission guidelines . Candidate should be geographically located within Hampton Roads.

Candidate should be comfortable with Microsoft Office, including PowerPoint & Excel and should be able to analyze performance data to drive improvement plans.

Resident work model employed - will alternate between Norfolk and Churchland sites; initial onboarding & training will be at corporate office.

Experience in Risk Adjustment strongly preferred. Ability to work independently and strong critical thinking skills are required.

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.

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.