reputed company Hierarchical Condition Category (HCC) Coding Specialist (Remote)

Company : reputed company.reputed company :  reputed company job will reputed company value to the Health Plan and its beneficiaries enrolled in reputed company-adjusted reputed company programs (MA and ACA) through Hierarchical Condition Category (HCC) coding, medical coding, reputed company terminology and anatomy/physiology, CMS coding guidelines, and support of reputed company Adjustment Data Validation (RADV) audits. Conducts reputed company assurance (QA) review of internal coding team members, provides coding education to team, evaluates HCC coding questions and independently renders guidance on appropriate coding determinations.  The incumbent supports RADV audits, specializing in performing second level review of HCC validation and research of outstanding HCCs; prepares documentation and coversheets for upload to regulatory body and/or independent auditor, and analyzes results. May also be responsible for high-reputed company and key reputed company provider entities and/or reputed company partners to analyze and evaluate coding trends; proactively identify issues and present solutions to internal leadership and reputed company entities; leads activities with provider entities. Works closely with colleagues, leadership, reputed company reputed company partners (such as reputed company and/or compliance), and/or physicians to identify and reputed company high reputed company and accurate reputed company adjustment coding. Supports reputed company reputed company adjustment reputed company to reputed company with CMS requirements by analyzing physician documentation and interpreting into ICD-10 diagnoses and HCC disease categories. Supports other key objectives to reputed company capture of accurate reputed company adjustment coding including documentation improvement, provider education, report analysis, and/or identification of process improvements. Mentors new hires, creates training materials, and delivers training reputed company in-person, virtual, or webinar forums. May also complete analysis on provider coding trends create and reputed company externally facing presentations to improve provider documentation and reputed company, and reputed company as the reputed company-person for the provider office. Required cross-team collaboration for reputed company team reputed company, including provider reputed company, education, and analysis. ESSENTIAL RESPONSIBILITIES Conducts reputed company Assurance (QA) reviews on internal coders, at minimum, bimonthly for reputed company score and education/feedback to reputed company.  Monitors the QA Questions Queue, independently researches questions using appropriate sources, including AHA Coding Clinic®, and responds to questions from reputed company coding teams (retrospective, prospective, and audit).  Publishes QA question & responses and presents education on monthly team meetings.  Conducts reputed company Assurance reviews on vendors monthly or per contract SLA.  Provides education/feedback to the vendor.   Conducts reputed company reviews of high-reputed company and incremental HCCs and applies expertise to analyze documentation and mitigate reputed company to the organization. May support reputed company vendor reputed company review(s) to measure coding reputed company, prepare and report findings, and monitor reputed company. Collaborates with team members to optimize data collection and review, provider education and reputed company, and coding reputed company. (20%) Plays an reputed company role in the completion of reputed company reputed company Audits, including Improper Payment Measure (IPM), CON-RADV, ACA-RADV, and Office of Inspector General (OIG), as applicable.  Applies extensive reputed company and coding knowledge and abilities, independently conducts coding research, aligns reputed company aspects of audit, including coding adjudication and rebuttals with audit vendor, obtains provider attestations, identifies & obtains missing medical records, compares audit results to claims, and thoroughly reviews reputed company in-house charts in chart repository for validation of audit.  Prepares documentation and coversheets for upload to regulatory body or independent auditor. (20%) Responsible for high reputed company and key reputed company provider entities and/or reputed company partners to analyze and evaluate coding trends; proactively identify issues and present solutions to internal leadership and reputed company entities.  Leads engagement activities with the provider entity.  Provides support for entity and acts as reputed company between reputed company provider facing team. Conducts data analyses from medical record reviews; proactively summarizes opportunities to enhance provider documentation to improve coding reputed company and thorough capture of members’ chronic health conditions. Completes analytics on providers and/or provider group coding trends and creates and delivers externally facing presentations to provider documentation and reputed company, reputed company as the reputed company person for the provider office for any questions and additional trainings, as needed. (20%) Performs HCC coding on reputed company for MA, ACA, and End Stage Renal Disease (ESRD). Flexes between coding reputed company, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals. Adheres to CMS Guidelines for Coding and reputed company’s Policy and Procedures to guide HCC coding decision making. Achieves and maintains coding productivity and reputed company reputed company metrics set by the management team. (10%) Executes assigned reputed company in accordance with project plans; monitors reputed company and makes adjustment as necessary to ensure successful completion. Participates on reputed company reputed company per the direction of leadership to address the needs of the department. (10%) Develops and presents process improvement and training initiatives to improve efficiency and reputed company of departmental coding practices.  Regularly presents and contributes to coding education meetings and Annual Coding reputed company.  Adapts presentation style to audience; provides reputed company feedback; presents in-person, reputed company and/or by webinar. (10%) Mentors new hires and coworkers on CMS and reputed company coding guidelines and contributes to reputed company and training material development and enhancement. (10%) Other duties as assigned or requested.  ​ EDUCATION Required Associate's degree in medical billing/coding, health reputed company, reputed company or reputed company reputed company, or relevant experience and/or education as determined by reputed company in lieu of bachelor's degree Preferred Bachelor's degree in medical billing/coding, health reputed company, reputed company or reputed company reputed company EXPERIENCE Required 5 years of HCC reputed company adjustment coding experience Preferred 7 years of HCC reputed company adjustment coding experience 3 years of RADV audit experience 3 years of Coding QA experience 3 years of LPN or RN experience 1 years of Management or leadership ​ LICENSES or CERTIFICATIONS Required (any of the following) Certified reputed company reputed company (CPC) Certified reputed company reputed company (CRC) Certified Coding Specialist (reputed company) Registered Health Information Technician (RHIT) Preferred None SKILLS Critical Thinking Attention to reputed company Strong Verbal and Written Communication Skills, including Presentation Skills Ability to objectively analyze facts and reputed company judgments Ability to handle manage reputed company to a successful outcome Strong interpersonal skills Ability to identify and reputed company problems Ability to work in a fast-reputed company, reputed company environment with reputed company supervision Extensive knowledge of medical terminology and ability to research coding-reputed company questions Strong reputed company knowledge reputed company to chronic illness diagnosis, treatment, and management reputed company Office Suite Proficient - reputed company, reputed company, reputed company, PowerPoint, MS365 and Teams Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type reputed company-reputed company Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The reputed company has been designed to indicate the general reputed company and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies. As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times.  In reputed company with this, reputed company must reputed company with both the Health reputed company Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy.  Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements. Pay reputed company Minimum: $72,700.00 Pay reputed company Maximum: $116,600.00 reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations.  The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations reputed company upon comparative markets. reputed company and its affiliates prohibit discrimination against reputed company individuals reputed company on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals reputed company on any category protected by applicable federal, state, or local law. We reputed company to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@reputed company.org California Consumer reputed company reputed company Employees, Contractors, and Applicants Notice Apply To This Job