Summa Health
Risk Adjustment - Coder, Audit Specialist
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days
HYBRID - LOCAL
Are you a coding expert who thrives on accuracy, compliance, and making an impact in healthcare? Do you have strong knowledge in the area of HCC coding? If so, this may be a fit for you! This position is hybrid, located in Akron, Ohio.
Summary Performs chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions / issues. Determines adequacy and correctness of physician diagnosis / documentation as it relates to risk adjustment.
Formal Education Required
a. Associate degree or equivalent combination of education and / or experience.
Experience & Training Required
a. Five (5) years experience to include leadership experience, medical chart reviews, risk adjustment experience with in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding.
Essential Functions
Has the ability to oversee the chart review life cycle from scheduling access, collecting images, coding chart, development of the supplemental record, and submission of the RAPS file to CMS.
Determines adequacy and correctness of medical documentation as it relates to risk while actively identifying and implementing opportunities for improvement.
Serves as a resource regarding quality coding per guidelines as well as supervising the quality of internal and external coders.
Develops policies, procedures, operational workflows, auditing worksheets and other documentation to improve and support department processes concerning risk adjustment, risk mitigation and RADV activities.
Oversees periodic audits of revenue realization activities, implements quality oversight on the retrospective chart review process, home visits and bidirectional reviews and reports findings to the Director of Risk Adjustment as well as develops solutions and / or corrective action plans.
Is the primary liaison with the provider community and is the official representative to the Health Plan Alliance Coding workshops.
Works with SummaCare Medical Directors to educate and provide feedback to provider offices about medical record documentation and coding issues to facilitate accurate claims submissions and reduce the risk exposure to a RADV audit.
Ensures all Level 1 coders maintains updated knowledge of coding requirements, through continuing education and certification renewal.
Prepares educational materials on coding requirements and conducts training to ensure the accuracy of the medical records review process.
Coordinates user group meetings, conference calls and training sessions and ensures attendance documental is supplied to Compliance.
Assists in defining the parameters for chart chase logic and assists in development of all internal / external risk adjustment associated tools related to revenue enhancement or risk mitigation.
Performs all job functions with integrity. Provides timely internal and external customer service in cooperatives, professional, and respectful manner.
Other Skills, Competencies and Qualifications
b. Ability to obtain Certified Risk Adjustment Certification (CRC) from American Academy of Professional Coders (AAPC) within 6 months of hire.
c. Demonstrate knowledge of Microsoft Office suite and other software for electronic processing of medical records.
d. Maintains up-to-date knowledge on risk adjustment HCC (Hierarchical Condition Categories) processing concerning ICD 9 and ICD 10 coding guidelines.
e. Maintain current knowledge of medical coding concepts, techniques and principles in regards to risk management activities.
f. Understands medical chart review processes and effectively translate the associated business needs into appropriate solutions and actions.
g. Demonstrate strong attention to detail and understanding the medical record in order to determine the appropriate health conditions (correct diagnosis codes) that should be submitted as additions or redactions for risk adjustment.
h. Organize and manage time to accurately complete tasks within designated periods in fast-paced environment.
i. Maintain current knowledge of, comply with regulatory, and company policies and procedures.
j. Maintain confidentiality of patient and business information.
k. Flexible: ability to adjust work hours to meet business demands.
Level of Physical Demands
a. Sit for prolonged periods.
b. Bend, stoop, and stretch.
c. Lift up to 20 pounds.
d. Manual dexterity to operate computer, phone, and standard office machines.
Equal Opportunity Employer / Veterans / Disabled
$25.54 / hr - $38.32 / hr
The salary range on this job posting / advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short-Term and Long-Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
#J-18808-Ljbffr
Full-Time / 40 Hours / Days
HYBRID - LOCAL
Are you a coding expert who thrives on accuracy, compliance, and making an impact in healthcare? Do you have strong knowledge in the area of HCC coding? If so, this may be a fit for you! This position is hybrid, located in Akron, Ohio.
Summary Performs chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for both Medicare and ACA services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for coding questions / issues. Determines adequacy and correctness of physician diagnosis / documentation as it relates to risk adjustment.
Formal Education Required
a. Associate degree or equivalent combination of education and / or experience.
Experience & Training Required
a. Five (5) years experience to include leadership experience, medical chart reviews, risk adjustment experience with in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding.
Essential Functions
Has the ability to oversee the chart review life cycle from scheduling access, collecting images, coding chart, development of the supplemental record, and submission of the RAPS file to CMS.
Determines adequacy and correctness of medical documentation as it relates to risk while actively identifying and implementing opportunities for improvement.
Serves as a resource regarding quality coding per guidelines as well as supervising the quality of internal and external coders.
Develops policies, procedures, operational workflows, auditing worksheets and other documentation to improve and support department processes concerning risk adjustment, risk mitigation and RADV activities.
Oversees periodic audits of revenue realization activities, implements quality oversight on the retrospective chart review process, home visits and bidirectional reviews and reports findings to the Director of Risk Adjustment as well as develops solutions and / or corrective action plans.
Is the primary liaison with the provider community and is the official representative to the Health Plan Alliance Coding workshops.
Works with SummaCare Medical Directors to educate and provide feedback to provider offices about medical record documentation and coding issues to facilitate accurate claims submissions and reduce the risk exposure to a RADV audit.
Ensures all Level 1 coders maintains updated knowledge of coding requirements, through continuing education and certification renewal.
Prepares educational materials on coding requirements and conducts training to ensure the accuracy of the medical records review process.
Coordinates user group meetings, conference calls and training sessions and ensures attendance documental is supplied to Compliance.
Assists in defining the parameters for chart chase logic and assists in development of all internal / external risk adjustment associated tools related to revenue enhancement or risk mitigation.
Performs all job functions with integrity. Provides timely internal and external customer service in cooperatives, professional, and respectful manner.
Other Skills, Competencies and Qualifications
b. Ability to obtain Certified Risk Adjustment Certification (CRC) from American Academy of Professional Coders (AAPC) within 6 months of hire.
c. Demonstrate knowledge of Microsoft Office suite and other software for electronic processing of medical records.
d. Maintains up-to-date knowledge on risk adjustment HCC (Hierarchical Condition Categories) processing concerning ICD 9 and ICD 10 coding guidelines.
e. Maintain current knowledge of medical coding concepts, techniques and principles in regards to risk management activities.
f. Understands medical chart review processes and effectively translate the associated business needs into appropriate solutions and actions.
g. Demonstrate strong attention to detail and understanding the medical record in order to determine the appropriate health conditions (correct diagnosis codes) that should be submitted as additions or redactions for risk adjustment.
h. Organize and manage time to accurately complete tasks within designated periods in fast-paced environment.
i. Maintain current knowledge of, comply with regulatory, and company policies and procedures.
j. Maintain confidentiality of patient and business information.
k. Flexible: ability to adjust work hours to meet business demands.
Level of Physical Demands
a. Sit for prolonged periods.
b. Bend, stoop, and stretch.
c. Lift up to 20 pounds.
d. Manual dexterity to operate computer, phone, and standard office machines.
Equal Opportunity Employer / Veterans / Disabled
$25.54 / hr - $38.32 / hr
The salary range on this job posting / advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.
Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short-Term and Long-Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
#J-18808-Ljbffr