Clinical Operations Risk Adjustment Coder

July 20

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Reveleer

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51 - 200 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤖 Artificial Intelligence

Description

• 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 within 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) all projects • Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs) • Maintaining an accuracy score of 95% on all work submitted (all projects) • Ability to adapt to changing priorities in managing a wide range of projects. • Must be able to work independently and in a team environment • Remote mentoring/ coaching (for all projects) in a group or 1:1 session with staff and leadership • Client trainings (Reveleer technology, if needed) • Over read challenges for all projects (reviewing abstractor/coder 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 make sure sufficient headcount are assigned per workload (all 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 all coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA 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

Requirements

• Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS) through AAPC and/or AHIMA. • Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial 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 • 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 range of projects • Adaptive and flexible to new ideas 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 perform job functions • Excellent written and communication skills and the ability to explain complex information