41 medical risk adjustment specialist jobs found

Virtua Health Coding Specialist Evaluates and analyzes medical records for proper documentation and the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models. Position Responsibilities: Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding. Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings. Manages and trends data collection for HCC and other...

Virtua Health Coding Specialist Evaluates and analyzes medical records for proper documentation and the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models. Position Responsibilities: Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding. Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings. Manages and trends data collection for HCC and other...

Coder II - ProFee Trauma Surgery Location: Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:30:00 PM Minimum to Midpoint Pay Rate: $20.50 - $27.85 / hour This is a remote position. Incumbents, who reside in Florida only, may work remotely. There may be occasional situations that require work to be performed on-site at an assigned Lee Health location. Summary Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Includes inpatient E/M coding and clinic E/M coding as well as trauma surgery...

Coder II - ProFee Surgery Location: Remote - FL Department: Coding Work Type: Full Time Shift: Shift 1/8:00:00 AM to 4:30:00 PM Minimum to Midpoint Pay Rate: $20.50 - $27.85/ hour This is a remote position. Incumbents, who reside in Florida only, may work remotely. There may be occasional situations that require work to be performed on-site at an assigned Lee Health location. Summary Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows procedures mandated by government and other payers for completion of coded data including APC assignments. Professional Fee Specific: Responsible for coding Surgical Records, Evaluation &...

Virtua Health Coding Specialist Evaluates and analyzes medical records for proper documentation and the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models. Position Responsibilities: Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding. Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings. Manages and trends data collection for HCC and other...

Certified Medical Coder The certified medical coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with risk adjustment requirements. Key responsibilities include following CMS risk adjustment guidelines and having a complete understanding of their real-world application. The coder reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission. They accurately and completely code all diagnoses and services from the medical record in accordance with the ICD-10-CM coding classification system. The coder selects and accurately records all appropriate records and data on assigned chart abstraction projects and is able to meet productivity and accuracy requirements. Other duties as assigned are also performed. Qualifications include a high school diploma or GED, a certification...

Virtua Health Coding Specialist Evaluates and analyzes medical records for proper documentation and the correct diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models. Position Responsibilities: Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding. Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings. Manages and trends data collection for HCC and other...

Job Description Job Description Lamoille Health Partners is looking for a Certified Medical Coder to accurately translate diagnostic and procedural information from patient medical records into standardized codes. The Medical Coder plays a crucial role in ensuring accurate billing and reimbursement, as well as contributing to valuable healthcare data collection. ESSENTIAL FUNCTIONS: Review and analyze patient medical records, including physician notes, operative reports, laboratory and radiology results, and discharge summaries, to identify pertinent diagnoses and procedures. Accurately assign ICD-10-CM, CPT, and HCPCS codes according to official coding guidelines and regulations. Ensure proper sequencing of codes to optimize reimbursement and meet payer requirements. Abstract relevant information from medical records, including patient demographics, diagnoses, procedures, and dates of service. Identify and resolve coding discrepancies, errors, and omissions by...

Business (Non-Clinical) Project Coordinator As an integral member of the HAP Medical Policy Team, the Project Coordinator will be responsible for research and guidance on coding such as CPT, HCPCS, ICD used in the development and maintenance of Benefit Administration Manual policies and HAP's coverage tool (Master Tiering Database) as well as actively participate in various HAP code-related committees and ad hoc projects. Principal Duties and Responsibilities: Conduct research for development and update of codes for Benefit Administration Manual policies and the Master Tiering Database, requests by the Utilization Management Committee and HAP code-related committees, and other issues such as new technology. Maintain organized documentation of findings from research as well as proposed resolutions. Research all types of codes (e.g., CPT, HCPCS, ICD) including new codes, existing codes, additions and deletions of codes, use of modifiers, and revenue codes to be compliant with...

Coding Specialist 1 - Edits Coder UW Medicine Enterprise Records and Health Information has an outstanding opportunity for a Coding Specialist 1 - Edits Coder. The Edits Coder position reports to the Outpatient Coding Supervisor within the Enterprise Records and Health Information Management department. Under the general supervision of the Manager of Facility Coding, and the direct supervision of the Supervisor of Outpatient Coding, the Edits Coder is responsible for implementing the mission and goals of Enterprise Records and Health Information, and incorporating a "patients are first" service culture. The Edits Coder is responsible for performing daily activities related to analyzing medical records to validate the correct coding assignment of International Classification of Disease (ICD), Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) codes in Epic work queues (WQ) and/or Hierarchical Condition Category (HCC)/Risk Adjustment...

Job Posting Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to maximize quality payments and risk...

Quality Risk Adjustment Coder (San Gabriel Valley, CA) Department: Quality - Risk Adjustment Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Brian Ramos Compensation: $75,000 - $85,000 / year Description We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. Requires travel to provider sites in San Gabriel Valley Area May be open to considering Level I Specialists based on experience and skills Our Values: Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative Work As One Team What You'll Do Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver...

Are you an experienced Medical Coder seeking a career growth? Are you a Certified Auditor interested in a new work opportunity? If so, then we want to connect with you! MAHEC is now accepting candidates for Medical Auditor. This integral role supports MAHEC's mission of educating the next generation of healthcare professionals by completing internal quality assessment reviews on Care Provider coding and effectively builds relationships with MAHEC Care Providers to educate and foster complete, accurate, timely, and consistent coding. The Auditor/Provider Educator is responsible for documentation to ensure compliance with national coding guidelines and MAHEC policies. We welcome experienced Medical Coders interested in becoming a Certified Professional Medical Auditor, and MAHEC offers an employer-sponsored pathway to CPMA certification if hired for the position! This is a hybrid work opportunity, with roughly 50-60% onsite work to support in-person collaboration and...

Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines...

Minimum Qualifications A high school diploma or GED and three years of multi-specialty coding experience. The senior coder must be proficient in coding Professional services, and/or Outpatient professional and hospital technical services. Must also have experience with communicating, training, and educating providers in proficiency. Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations is a plus. Licenses, Registrations, or Certifications CCA - Certified Coding Associate American Health Information Management (AHIMA) CCS - Certified Coding Specialist American Health Information Management (AHIMA) CCS-P - Certified CCS-P Physician Based American Health Information Management (AHIMA) RHIA - Certified Reg Health Inform. Admins American Health Information Management (AHIMA) RHIT - Certified Reg Health Inform. TECH American Health Information Management (AHIMA) CIC - Certified Inpatient Coder American...

Join to apply for the Coder II – Revenue Integrity role at Lee Health Location: Santa Barbara Professional Center – 224 Santa Barbara Blvd, Cape Coral, FL 33991. Department: Lee Professional Billing. Work Type: Full Time. Shift: 8:00 AM – 4:30 PM. Pay Rate: $20.50 – $27.85 per hour. Job Summary Lee Health is seeking an experienced Medical Coder II Revenue Integrity to support accurate, compliant outpatient and professional fee coding across our health system. In this role, you’ll abstract detailed clinical, demographic, and statistical information from medical records and apply correct ICD‑10‑CM, CPT‑4, and APC guidelines. This position plays a key role in our Reconciliation Reduction and Provider Education Project, partnering with Charge Review, reconciliation workflows, and data analysis tools to improve accuracy and financial integrity. The ideal candidate is a self‑starter, highly analytical, skilled in communication, and comfortable presenting findings to leaders and...

Overview Join to apply for the Coder II - ProFee Surgery role at Lee Health . Remote position for Florida residents. Location: Remote - FL. Department: Coding. Work Type: Full Time. Shift: 8:00 AM to 4:30 PM. Minimum to Midpoint Pay Rate: $19.89 - $27.85 / hour. This is a remote position; incumbents residing in Florida may work remotely. There may be occasional on-site work at an assigned Lee Health location. Details Location : Remote - FL Department : Coding Work Type : Full Time Shift : 8:00 AM to 4:30 PM Minimum to Midpoint Pay Rate : $19.89 - $27.85 / hour Summary Abstracts data from medical records into Epic and 3M 360 to provide a detailed case summary of medical, demographic, and statistical information. Identifies and codes diagnoses and procedures for medical records according to ICD-10-CM and CPT-4 guidelines, including department modifications. Identifies primary diagnosis and procedure as well as pertinent secondary diagnoses and procedures. Follows...

Join to apply for the Health Information Management Inpatient Coding Auditor Sr. FT, Days, - Remote role at Prisma Health . Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employ critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Reviews and responds to inpatient denials as needed. Performs Inpatient coding by assigning ICD-CM and ICD-PCS codes as well as DRG assignment. Essential Functions All team members are expected to be...

Join to apply for the Compliance Auditor Analyst role at Upstate Medical University 5 months ago Be among the first 25 applicants Join to apply for the Compliance Auditor Analyst role at Upstate Medical University Get AI-powered advice on this job and more exclusive features. Job Summary Position Summary: Under the direction of the Compliance Officer the main duties for this position include: analysis of professional coding and billing data, review of applicable regulations or guidelines and professional coding and billing audits. Duties/Responsibilities Analysis of coding and billing data, identification of trends and aberrations. Performance of routine and investigatory audits evaluating compliance with applicable laws, regulations, coding, and billing guidelines. Interpretation of coding, billing, and regulatory standards. Preparation and completion of audit reports including recommendations, education and corrective action. Knowledge, Skills and Abilities: Strong...

Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports use of alternatives and solutions to maximize quality payments and risk adjustment. Translates...

Summary Certified Medical Coder role is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10-CM, HCPCS, and CPT coding and compliance with Risk Adjustment requirements. Key Responsibilities Follows CMS Risk Adjustment guidelines and has a complete understanding of their real-world application. Reviews submitted medical records to identify ICD-10-CM diagnoses, ensuring the documentation meets all CMS standard requirements for valid submission. Codes all diagnoses and services accurately and completely, from the medical record in accordance with the ICD-10-CM coding classification system. Selects and accurately records all appropriate records and data on assigned chart abstraction projects. Ability to meet productivity and accuracy requirements. Performs other duties as assigned. Qualifications High School Diploma or GED required. A certification in one of the following is required: Certified Professional...

A healthcare organization is seeking a Certified Risk Adjustment Coding Specialist for a full-time remote position with onsite training in Livonia, MI. The role involves assigning ICD/CPT codes, ensuring compliance with documentation standards, and providing education on coding practices. Ideal candidates will have relevant certifications, experience in risk adjustment coding, and strong communication skills. Comprehensive benefits including medical coverage from the first day are offered. #J-18808-Ljbffr

Quality Risk Adjustment Coder (San Gabriel Valley, CA) Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Compensation: $75,000 - $85,000 / year Department: Quality - Risk Adjustment About the Role We are currently seeking a highly motivated Risk Adjustment Coding Specialist. This role will report to a Sr. Manager - Risk Adjustment and enable us to continue to scale in the healthcare industry. The staff is required to frequently travel to provider sites depending on projects. What You’ll Do Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACA) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company. Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter...