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Experience in key areas of healthcare payer or provider operations, CMS Risk Adjustment and HCC coding process and quality including Medicare Star Ratings and HEDIS. The role requires expertise in areas that include performance management/analytics, data exchanges, electronic medical record systems, provider workflow and processes, health information management, risk adjustment operations (particularly on the prospective side), value-based care, ICD-10, CPT and HCPCS coding principles and guidelines, and population health management.
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Looking for a full time clinician to work at a County Health Center assisting with Quality Improvement projects and help close gaps in patient care for quality metrics from HEDIS and HRSA (UDS.
Full-timeExpandApply NowActive JobUpdated 24 days ago - UpvoteDownvoteShare Job
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Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. This role is responsible for supporting Cigna Medicare Advantage risk adjustment prospective programs, solutions, and performance in aligned operational region serving as a liaison between Markets and Provider Performance Enablement teams, Provider Education, and the Risk Adjustment Operations teams.
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Maintain and or communicates with partner departments, the provider and practice alignment within applications essential to quality programs, including but not limited to; patient satisfaction (NRC), EPIC and MIPS/MVP and HEDIS scorecards, State Vaccination registry.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Knowledge of New York State Medicaid and CMS Medicare regulations and related reporting requirements such as STARS, QARR, MMCOR, MEDS, RAPS, EDGE and HEDIS required. Working knowledge of health care EMR or claims systems (Epic/Clarity, eCW, Facets, QNXT, Amisys, etc.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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About Cigna Healthcare. The role will work under the direction of the Senior Manager - National Lead Provider Education to reach overall operational market goals in conjunction with market Provider Performance Enablement teams and the Risk Adjustment Operations team.
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Documentation Integrity, Coding or Health Information Management Certification through AHIMA, AAPC or ACDIS preferred. Function as a Risk Adjustment and Quality SME to support engagement with market and matrix partners and supports in a consultative way to solution for barriers identified impacting participation with Cigna RA prospective programs.
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Serves as a bridge with market teams and risk adjustment for implementation discussions. The Prospective Program Solutions & Performance Advisor works with aligned region supporting prospective risk adjustment initiatives and programs aimed at improving the accuracy and completeness of risk adjustment, advising the market on risk adjustment strategy based on knowledge of Cigna MA's overall Risk Adjustment programs, with a strong focus on alternate prospective programs and bi-directional data exchange initiatives, and overseeing regional and market program performance.
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Demonstrated knowledge of Hedis and QARR quality measures, ICD- 10 and CPT coding for reimbursement of services , required. Manages and provides clinical services in compliance with standards of Patient -Centered Medical Home standards, meaningful use of medical record data, HEDIS and QARR quality of care measurements.
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Advises and educates Provider practices in appropriate HEDIS measures and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements. Licensed Social Worker (LSW) Advises and educates Provider practices in appropriate HEDIS measures and HEDIS ICD-10 /CPT coding in accordance with NCQA requirements.
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This position requires the coder to be highly proficient in the proper assignment of ICD-10 CM, PCS, CPT, HCPCS, HCC, HEDIS CAT II, E/M and modifier codes. The primary purpose of the Coding Specialist II is to code and verify charge data necessary to ensure correct coding, abstracting, and billing on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS), specialty clinics and/or inpatient OB/newborn encounters.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Serves as strategic advisor for market specific prospective risk adjustment strategy and solutions. Serve as liaison to share updates with markets/PPE team on risk adjustment programs and strategy. Responsible for identifying and influencing adoption of processes to improve the accuracy and completeness of risk adjustment in the aligned markets.
$72,400 - $120,600 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Code, abstract and conduct charge quality review on all episodes of care on emergency department (ED), same day surgery (SDS), outpatient clinic (OPC), observation (OBS) and/or inpatient OB/newborn hospital and specialty clinic encounters according to coding conventions, guidelines, and hospital policy, analyzing questionable documentation to ensure to the accuracy of information and resolves identified issues.
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Providing elbow support and training to IPA Physicians and Advanced Practice Providers on Medicare documentation guidelines, HEDIS/Quality measures, and clinic workflows that align with Value Based Care delivery models.
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Knowledge of regulatory and certification requirements and their impact on the organization such as CMS, HCA, HEDIS, CAHPS, and NCQA. Current, unrestricted license in the State of Washington as a Mental health Counselor (LMHC), Mental Health Professional (LMHP), or Marriage and Family Therapist (LMFT) (required.
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