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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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Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or coding of technical outpatient accounts including, but not limited to Observation, Radiation Oncology, Chemotherapy Infusion, Cardiac Cath/Electrophysiology or Interventional Radiology and Surgery to support Revenue Cycle goals for timely billing.
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Coding certification required (at least one of the below): Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Certified Coding Specialist for Providers (CCS-P) Certified Coding Specialist for Hospitals (CCS-H) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA.
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Required Certifications/Registrations/Licenses Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential.
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In-depth knowledge of risk adjustment coding methodologies, including HCC (Hierarchical Condition Category) coding. Responsible for reviewing and analyzing medical records, assessing the accuracy of diagnostic coding, and identifying opportunities for improvement in risk adjustment documentation and coding practices.
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JOB DESCRIPTIONRequired:High school diploma or GEDAt least one of the following certifications is required: CPC, COC, CIC or CCA, COC-A along with a CPMA, CRC, CPC-I, RHIT, or RHIA.4+ years of experience in coding in health care facility or physician office specifically in specialty and surgical coding.
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Additional Coding certification preferred (CCS, CPC, or RHIT) Must be credentialed through AAPC or AHIMA. 2+ years in Risk Adjustment Coding Experience working in a variety of EMRs and the ability to navigate and pick up EMR applications agree Strong understanding and knowledge of CMS Coding and Documentation Guidelines agree Demonstrated competency in HCC coding practices.
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Explain the responsibilities of the billing and coding specialist to protect patient rights under HIPAA. Demonstrate a basic understanding of the anatomy and physiology of body systems and related medical terminology in order to properly process clean claims.
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Audit all RAPS submissions to ensure accuracy in the data provided to CMS. Provide coding expertise as well as administrative oversight to ensure successful integration of AHC's HCC initiatives.
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The Compliance Auditor - OP/Ambulatory Services educates physicians and staff on error trends and how to prevent/reduce errors to demonstrate compliance with the False Claims Act, the Federal Overpayment Rule, CMS and Medicaid billing and coding requirements to maximize reimbursement.
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Bonus PointsCertified Risk Adjustment Coder (CRC) or similar certificationExperience coding in multiple different Electronic Medical Record (EMR) systems. Certified professional coder (CPC)2+ year(s) retrospective risk adjustment coding experience.
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Optum Care Network Washington is seeking a full-time Nurse Practitioner - Population Health Education & Clinical Performance who works collaboratively to educate on and improve accurate coding and documentation skills, leading to a more complete patient record, as well as other value-based care initiatives.
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The Coding Director serves as an integral resource and works collaboratively with the Vice President of Revenue Cycle Management, Revenue Cycle Senior Director, Health Information Management Senior Director, Patient Access Senior Director and Care Management and Local Hospital Leadership where responsible for implementing standardized process as part of the World Class Revenue Cycle/Coding department initiative at Maine Health.
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CERTIFICATION & LICENSURE: Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP)Certified Coding Specialist (CCS) or Certified Professional Coder (CPC)SKILLS AND KNOWLEDGE:Knowledge of Pathophysiology and Disease Processes sufficient to pass the clinical pre-employment test at a rate of 85% or better is required for new hires.
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Description : JOB SUMMARYThis 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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coding job Title: developer Company: Experis
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