Risk Adjustment Coding & Documentation Specialist

Risk Adjustment Coding & Documentation Specialist page is loaded## Risk Adjustment Coding & Documentation Specialist remote type:
Hybrid locations:
SMG Administration time type:
Full time posted on:
Posted Todayjob requisition :
JR-88799
** City/State
** Virginia Beach, VA
** Work Shift
** First (Days)
** Overview:**#
** Overview
* * 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/Certification/Experience
*** 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.
** 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
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance   
• Legal Resources Plan  
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
** Sentara Health is an equal opportunity employer
** and 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  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.
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