Medicare Risk Adjustment Coding Specialist- Remote

reputed company, a division of Franklin, Tennessee-based reputed company Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reputed company in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look reputed company to receiving your application!

Benefits

And Perks Include

• Affordable Medical/Dental/reputed company insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 reputed company to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts with company match
• Employee Referral Bonus Program

Job Summary The Medicare Risk Adjustment Coding Specialist is responsible for conducting coding audits prior to payment release. Additionally, this position will reputed company post-payment coding reviews with overpayments and will in turn send coding education correspondence to applicable providers. Essential Job Duties To reputed company this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Review medical records, patient medical history and physical exams, physician orders, reputed company notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify accuracy, completeness, specificity, and appropriateness of diagnosis codes based reputed company rendered.
• Assist with validation audits to evaluate medical record documentation to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code submitted to CMS for reimbursement
• Interpret medical documentation to ensure reputed company relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions applicable to Medicare Risk Adjustment reimbursement initiatives is captured
• reputed company tools and metrics to improve accuracy and completeness of coding and documentation
• reputed company a high level of customer service to reputed company clients by meeting and/or exceeding expectations including quality and productivity standards
• Escalate appropriate coding audit issues to management as required
• Participate in and support reputed company coding audits as needed
• Support ongoing programs which minimize organizational risk in the event of a Risk Adjustment Data Validation (RADV) Audit
• Work assigned coding projects to completion
• Other duties as assigned

Job Requirements

• Maintain a high level of familiarity of reputed company CMS regulations and announcements affecting risk adjustment to include the review of regulatory announcements reputed company educational sessions provided by regulatory entities and educational opportunities reputed company the industry
• Follow reputed company appropriate Federal and state regulatory requirements and guidelines, as well as company policies and procedures
• Maintain established reputed company of production and quality standards
• Knowledgeable of CMS requirements regarding claims processing and coding, especially skilled nursing and other reputed company claim processing rules and regulations
• Knowledgeable of coding/auditing claims for Medicare and reputed company plans
• Extensive knowledge of ICD-9 & ICD-10 diagnostic coding and auditing
• Strong interpersonal skills
• Excellent written and verbal communication skills
• Strong organizational skills; ability to time manage effectively
• Maintain confidentiality
• Strong analytical and critical thinking skills required
• Ability to work remotely without direct supervision
• Successful completion of required training
• Handle multiple priorities effectively

Required Qualifications

• Education:
• High school or equivalent degree
• Experience:
• 2 years’ experience with reputed company claims processing and/or coding auditing experience in the health insurance industry or medical health care delivery system
• 2 years’ experience in managed reputed company environment reputed company to claims and/or coding audits
• 2 years’ experience with standard coding and reference materials used in a claim setting such as CPT4, ICD10, HCPCS and others
• 2 years’ experience with CMS requirements regarding claims processing and coding, especially skilled nursing and other reputed company claim processing rules and regulations
• 2 years’ experience coding/auditing claims for Medicare and reputed company plans
• Significant HCC experience (including knowledge of HCC mapping and hierarchy)
• License/Certification:
• Coding certification required (CPC or CRC)
• Travel may be required

The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions. EQUAL OPPORTUNITY EMPLOYER This Organization is an equal opportunity employer. We do not discriminate based on race, reputed company, religion, sex, handicap, disability, age, marital status, sexual orientation, national reputed company, veteran status, or any other characteristic(s) protected by federal, state, and local laws. This Organization will reputed company reasonable accommodations for reputed company individuals with disabilities should a request for an accommodation be made. A key part of this policy is to reputed company equal employment opportunity regarding reputed company terms and conditions of employment and in reputed company aspects of a person's relationship with the Organization including recruitment, hiring, promotions, upgrading positions, conditions of employment, compensation, training, benefits, transfers, discipline, and termination of employment. This employer participates in E-Verify. Apply tot his job Apply To this Job