Risk Adjustment Coding & Documentation Specialist

Sentara Medical Group is now hiring a Risk Adjustment Coding & Documentation Specialist in Charlottesville, VA! This is a full-time position, Monday-Friday, no nights, holidays, or weekends.
This role consists of educating primary & specialty care 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 .
Candidate should be geographically located within the Charlottesville/Blue Ridge area in order to visit practice sites within the region.
Hybrid work model employed – office space available with expectation 1-2 days/week in office; initial onboarding & training will be in-office.
Previous HCC coding experience STRONGLY PREFERRED Qualifications: Coding - 2 years Experience required.
Medical Records Data - 1 year experience required.
Associate's preferred but not required.
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 This role consists of educating primary & specialty care 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 .
Candidate should be geographically located within Hampton Roads to be able to visit practice sites within the area.
Candidate should be comfortable with Microsoft Office, including PowerPoint & Excel and should be able to analyze performance data to drive improvement plans.
Hybrid work model employed – office space available with expectation 1-2 days/week in office; initial onboarding & training will be in-office.
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.
Certified Professional Coder (CPC) - Certification - American Academy of Professional Coders (AAPC) Associate's Level Degree Coding 2 years Medical Records Data 1 year Mathematics Service Orientation Reading Comprehension Active Listening Leadership Active Learning Writing Judgment and Decision Making Troubleshooting Monitoring Critical Thinking Microsoft Word Time Management Coordination Technology/Computer Microsoft Excel Speaking Communication Social Perceptiveness