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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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Educate providers on proper coding, risk adjustment metrics, capturing documentation, and adhering to quality protocols. 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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Certified Risk Adjustment Coder Certification. They will stay abreast of current changes to the Risk Adjustment field and continue education to maintain high level proficiency.
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A certification in one of the following is required: Certified Professional Coder (CPC) Certified Risk Adjustment Coder (CRC) Certified Coding Specialist (CCS) A license in one of the following is preferred: Certified Professional in Healthcare Quality (CPHQ) Licensed Vocational Nurse (LVN) Registered Nurse (RN.
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Utilize statistical models (CDPS, Client Risk Adjustment, 3M) to identify trends in utilization and performance over time. Demonstrates Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness, and caring service.
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Coach clinic staff to provide effective ongoing monitoring of performance metrics related to Value based Care (Quality, Risk Adjustment, and MLR). Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment.
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We are seeking a qualified and experienced individual to join our team as Clinical Data Abstraction Team Lead. In this role, you will lead a team of clinical abstraction specialists responsible for analyzing patient medical records to ensure accurate coding for Risk Adjustment and HEDIS purposes.
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Evaluate the impact of Medicare quality and risk adjustment program has on our MA risk contracts and ACOs (MSSP and ACO REACH), including but not limited to risk adjustment opportunities, HCC gaps, and benchmarking analysis.
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CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC) CRC - Cert Risk Adjustment Coder by the American Academy of Professional Coders (AAPC) COC - Certified Outpatient Coder by the American Academy of Professional Coders (AAPC.
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Collaborates with Provider Relations to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Required A Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field or equivalent work experience within a managed care environment related to HEDIS record review, quality improvement, medical coding or transferable skill sets that demonstrates the ability to perform the role.
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Certified Professional Coder (CPC) required; Certified Risk Adjustment Coder (CRC) preferred. Extensive knowledge of federal laws and regulations affecting risk adjustment documentation and coding compliance.
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Experience in physician compensation, billing, capitation, risk adjustment, CPT coding, and resource-based relative value scale (RBRVS) Experience in hospital, health plan, risk-based care delivery organizations or physician claims analytics.
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High School Diploma or Equivalent (Required) and Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) by AAPC. For Hospital Billing, Certified Coding Specialist (CCS), Certified Coding Associate (CCA) or Certified Professional Coder (CPC.
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Minimum of two (2) years of Risk Adjustment (HCC) coding experience in a managed care environment. Oversee audits and participate in provider education programs to ensure compliance with CMS risk adjustments diagnosis coding guidelines.
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Minimum of seven (7) years of experience in Risk Adjustment medical coding. Minimum of seven (7) years of experience in Risk Adjustment medical coding. Electronic Health Records (EHR) HEDIS experience preferred.
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risk adjustment jobs in Houston, TX
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