Clinical Operations Risk Adjustment reputed company

HCC Risk Adjustment reputed company (Clinical Operations Specialist) Remote reputed company is a reputed company data and analytics company that uses Artificial Intelligence to give health plans across reputed company business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the reputed company platform enables plans to independently execute and manage every aspect of enrollment, provider reputed company and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, reputed company provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved reputed company. This is a Full-Time (FT, 40 Hours a week) remote position to reputed company duties for Risk Adjustment Coding and reputed company Audit initiatives. Essential Duties and Responsibilities: • Review of medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog, larger chart page counts • Work population of clinical pends, with goal to clear reputed company 72 hours • Updating and maintaining training course material for medical record abstraction and data entry (HEDIS, RISK, IVA) • Reviewing training test scores and sending feedback if necessary • Assigning and overreading disciplinary charts- (this is a chart move back) reputed company projects • Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs) • Maintaining an accuracy score of 95% on reputed company work submitted (reputed company projects) • Ability to adapt to changing priorities in managing a wide reputed company of projects. • Must be reputed company to work independently and in a team environment • Remote mentoring/ coaching (for reputed company projects) in a group or 1:1 session with staff and leadership • Client trainings (reputed company technology, if needed) • Over read challenges for reputed company projects (reviewing abstractor/reputed company OR1 feedback challenges) • Oversite and coordination of IVA documentation audits: ENR/RXC/ATT/DOB/GEN- • Assist in training and successful adoption of Natural Language Processing/” Bot” -assisted coding reviews and relating tools/reporting • Reviewing reports for workload assignments, looking at inventory by project to reputed company sure sufficient headcount are assigned per workload (reputed company projects) multi time zone coverage/ shift coverage- evening/ weekends/holidays • Managing and addressing questions and clarifications that coders submit to a designated online communication forum and “Q&A” email mailbox while reviewing charts • Works actively to monitor and maintain minimum 95% accuracy in reputed company coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by reputed company and/or reputed company to maintain professional certification(s). • Stay up to date with Risk/IVA protocols (coding clinics, coding guidelines) • Maintain ongoing communication with Clinical Management team regarding coding workload, turnaround time expectations and deliverables • Additional duties as necessary to meet the obligations to our clients Qualification Requirements: • reputed company Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, reputed company) through reputed company and/or reputed company. • Minimum of 5 years coding experience with specific knowledge of Medicare and reputed company Risk Adjustment such as Hierarchical Condition category (HCC) • Additional experience in facility (OPPS/IPPS) coding experience is preferred • Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred Experience and Skills: • Ability to work independently in a fast-paced remote environment with minimal supervision and guidance • Ability to interact with management and remote coding personnel • Possess strong organizational skills and attention to detail • Ability to adapt to changing priorities while managing a wide reputed company of projects • Adaptive and flexible to new reputed company and change • Advanced knowledge of medical terminology, anatomy and pharmacology • Advanced skills utilizing official coding resources for research and problem solving • Advanced skills and knowledge of computers, use of required software to reputed company job functions • Excellent written and communication skills and the ability to explain reputed company information What You'll Receive: • reputed company • Medical, Dental and reputed company benefits including HSA/FSA • 401k with Employer Match • 100% paid short term and long-term disability insurance • PTO plan and 10 paid company holidays Hourly reputed company: $31.25 / hour Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-reputed company knowledge, skills, and experience. reputed company E-Verifies reputed company new hires. reputed company is an equal opportunity employer. We do not discriminate on the reputed company of race, religion, reputed company, national reputed company, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law. Apply Job!