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Posted: 09-Jan-25
Location: Los Angeles, California
Categories:
Internal Number: 145626566
As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. You will:
- Conduct medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions
- Analyze coding patterns within medical groups.
- Provide customized education and updating educational materials for providers and medical groups.
- Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews.
- Travel to provider offices within Los Angeles area at least three days a week.
Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.
We are seeking a proactive, highly organized, detail-oriented individual with:
- A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required
- A Certified Risk Adjustment Coder (CRC), required
- Registered Nurse (RN) or clinical qualifications a plus
- Bachelor’s degree (healthcare or relevant field) or equivalent experience/training
- Five or more years of experience with physician billing and/or coding, required
- Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28, required
- Three or more years of experience in providing education to clinical and non-clinical staff, required
- Six or more years of clinic or IPA and/or managed care experience, preferred
- Understanding of RADV and audit processes, required
- Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems required
- Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required
- Knowledge of Medicare Advantage billing/claims submission and other related actions, preferred
- Knowledge of HIPAA requirements, anatomy and physiology, required
- Proficient in MS Word, Excel, PowerPoint and Outlook, required
- Ability to work effectively with common office software, coding software, and EMR systems, required
- Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area, required
