Coder Auditor-Risk Adjustment
Company: Loma Linda University Health
Location: Loma Linda
Posted on: March 17, 2023
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Job Description:
- Managed Care (Full-Time, Day Shift) -
Our mission is to participate in Jesus Christ's ministry, bringing
health, healing, and wholeness to humanity by: Creating a
supportive faculty practice framework that allows Loma Linda
University School of Medicine physicians and surgeons to educate,
conduct research, and deliver quality health care with optimum
efficiency, deploying a motivated and competent workforce trained
in customer service and whole person care principles and providing
safe, seamless and satisfying health care encounters for patients
while upholding the highest standards of fiscal integrity and
clinical ethics. Our core values are compassion, integrity,
humility, excellence, justice, teamwork and wholeness.
The Coder Auditor-Risk Adjustment is responsible for the
reconciliation of Clinical Documentation Integrity (CDI)
clarification against final coded outcomes to ensure accurate and
timely encounter data submission as outlined within Risk Adjustment
Health Plans (i.e. Medicare Advantage). Evaluates provider
documentation in context of completed documentation, final code
diagnosis, severity of illness and supporting clinical care plan(s)
as it pertains to Risk Adjustment for the validation of
Hierarchical Condition Category (HCC) diagnoses. Maintains the HCC
Management database and LLEAP work queues, ensuring that all data
elements are thoroughly and consistently updated. Provides formal
education and training programs related to CMS, RADV, ICD-10-CM,
AHA Coding, health plan and other regulatory documentation
guidelines as it pertains to Risk Adjustment for Clinical
Documentation Specialists and providers Performs internal team
audits ensuring Clinical Documentation Specialists maintain at
least 95% coding and medical record review accuracy. Performs
concurrent, prospective, and retrospective clinical documentation
review within the designated timeframe after encounter closure,
with emphasis on completeness, accuracy, and supporting clinical
care plan(s) as it pertains to Risk Adjustment Data Validation
(RADV) timelines.
Performs other duties as needed.
Bachelor's degree in Health Information Management or other
clinical/healthcare degree required; however, an equivalent
combination of education and experience that provides proficiency
in the areas of responsibility, may be substituted for the stated
education and experience requirements.8+ years overall combined
clinical/medical experience with at least 5+ year of Risk
Adjustment coding specific experience or Clinical Documentation
Improvement/Specialist equivalentComprehensive understanding of the
contents of a typical electronic medical record, medical
terminology, abbreviations, ICD-10-CM coding conventions. Expertise
in CMS Risk Adjustment Data Validation (RADV) for Medicare
Advantage Plans, and medical coding, including but not limited to
E/M, ICD-10, CPT, and HCC coding preferred. Able to keyboard 40
wpm. Able to read; write legibly; speak in English with
professional quality; use computer, printer and software programs
necessary to the position; operate/troubleshoot basic office
equipment require for the position. Able to relate and communicate
positively, effectively, and professionally with others; be
assertive and consistent in following or enforcing policies; work
calmly and respond courteously when under pressure; collaborate;
and accept direction. Able to communicate effectively in English in
person, in writing, and on the telephone; think critically; work
independently with minimal supervision; performs basic math
functions; manage multiple assignments effectively; work well under
pressure; problem solve; organize and prioritize workload; recall
information with accuracy; pay close attention to detail. Able to
distinguish colors as necessary; hear sufficiently for general
conversation in person and on the telephone; identify and
distinguish various sounds associated with the workplace; see
adequately to read computer screens, medical records, and written
documents necessary to position.Certified Risk Adjustment Coder
(CRC) required; and Certified Clinical Documentation Specialist
(CCDS) preferred or equivalent. Active California LVN License
preferred.
Additional Information
Compensation
US Dollar (USD)
32.43
US Dollar (USD)
45.83
Keywords: Loma Linda University Health, Fontana , Coder Auditor-Risk Adjustment, Accounting, Auditing , Loma Linda, California
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