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This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits.
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3 years HCC coding and/or coding and billing. 5 years HCC coding and/or coding and billing. Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD.
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Associate degree in medical billing/coding, health insurance, healthcare or related field preferred. Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making.
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Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Engages in RPM Coding educational meetings and annual coding Summit.
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Perform audits as assigned by coding manager. Apply knowledge of MS DRG and APR DRG assignment, Official Coding guidelines, Comorbidity/complication coding, HAC Conditions, accurate POA assignment and current AHA coding clinic guidelines.
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Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
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Certified Coding Specialist (CCS) Build partnerships and work within coding teams and internal partners critical to HCC coding. Maintains RPM coding accuracy and productivity requirements.
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Strong experience in designing and coding responsive HTML email templates for optima display across devices. Design and code responsive HTML email templates for effective communication with the customers Collaborate with Marketing teams and other stakeholders to ensure timely execution of marketing communication across channels.
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The Coder IV is a member of the Health Information Management Team responsible for ensuring the accuracy and completeness of clinical coding validating the information in the databases for outcome management and specialty registries across the entire integrated healthcare system.
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We are seeking a qualified medical billing and coding specialist. Proven experience in medical billing and coding, with a strong understanding of ICD-10 coding guidelines and procedures.
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Portfolio Onboarding and New Account Coding - Provide oversight and support the process of interpreting the client's investment guidelines from the executed Investment Management Agreement (IMA) and implementing the required controls through use of the firm's investment management platform (BlackRock's Aladdin.
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Req ID : 1604 Working Title : Sr. Physician Coding Compliance Auditor Department : CSRC PB RCC Audit and Edu Business Entity : Cedars-Sinai Medical Center Job Category : Patient Financial Services Job Specialty : Revenue Integrity Overtime Status : EXEMPT Primary Shift : Day Shift Duration : 8 hour Base Pay : $38.87 - $60.25.
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Job SummaryThis expert level senior inpatient coder is responsible for leading coding teams, coder training, work que management, performing prebill and second-level coding reviews utilizing auditing software and documents findings to improve CC/MCC capture, Risk Variable capture, HAC/PSI, HCC and Quality Indicator validation.
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CSI Companies Coding and Clinical Data Integrity Practice is immediately seeking a Risk Adjustment Coding Project Manager (Remote) for a contract position with one of our clients in the payer space.
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Reporting to the Assistant Manager of Corporate Compliance of Connecticut Children's, the Hospital Coding Auditor contributes to the identification and reduction of CCMC's coding compliance risks, billing inaccuracies, and/or denials by coordinating independent reviews and assessments of the organization's hospital inpatient and outpatient and emergency department coding and billing transactions, processes, and internal controls for coding completeness and accuracy.
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