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PHPprime provides wrap-around services to help make our practice successful, including care coordination, practice transformation coaching, risk adjustment coding education, population health management, data and analytics, specialist network management, and large group contracting.
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Must be certified or obtaining certification for Certified Risk Adjustment Coder thru AAPC. If not obtaining, must obtain within one year if hired. Two-years of experience in a risk adjustment coding environment required.
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Certification may include Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA), or Risk Adjustment Coder (RAC), or Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) required.
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Collaborates in teaching clinicians and clinical operations teams about Medicare Risk Adjustment, Star ratings, and overall population health approach to patient care in both formal presentations and off the cuff at impromptu opportunities.
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Knowledge of managed care, including risk adjustment, affordability, quality, utilization management, care management, quality. Seeks to align Risk Adjustment, Quality, and Affordability initiatives internally and translate into ways network practices can actively engage in easily using these resources.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. 3+ years of experience in HEDIS record collection and risk adjustment (coding.
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The Optum Health East region is seeking an experienced clinician to support our Medicare risk adjustment education efforts. Working with the Medical Director for Risk Adjustment and the Chief Clinical and Value Officer in Optum East, this key physician will provide expertise in risk adjustment and HCC coding education for the markets in the Optum Health East region.
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Minimum - Certification as Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required, or Certified Risk Adjustment Coder (CRC) required within one year of hire for HCC.
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Update all education materials based on CMS-HCC Model and ICD-10 annual changes Suggest, update, and enhance clinical educational materials to assist in training physicians and clinical staff on Risk Adjustment Healthcare Programs including CMSHCC Models, Clinician Chart Reviews, and Encounter Documentation.
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Job SummaryUnder the direction of the Risk Adjustment Supervisor/Manager, performs accurate and timely review and validation of Medicare Advantage, Commercial and Medicaid HCCs through medical record reviews.
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The AVP will play a key leadership role on the HQRI team, partnering directly with the HQRI leadership team, leaders across the enterprise, including Market leadership, and external companies to create Medicare Risk Adjustment strategies to support Humana's industry leading position.
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In addition, the AVP will serve as a central point of contact for the lines of business as relates to key Stars and Risk Adjustment initiatives. Represent SVP, HQRI in enterprise level to ensure all Risk Adjustment and Stars/Quality impacts and opportunities are considered.
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The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives.
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Provides education to providers on coding and documentation for Medicare risk adjustment, quality, patient experience and affordability topic. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.
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Demonstrate knowledge of CMS Hierarchical Condition Category (HCC) Risk Adjustment coding. One of the following coding certifications: CPC, CIC, COC from American Academy of Professional Coders (AAPC) or CCA, CCS, RHIA, RHIT from American Health Information Management Association (AHIMA.
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