Hybrid Risk Adjustment Nurse/Coder (RN/CPC)

Sentara Health; Miami (FL); Hybrid; USD 71,000 - 109,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Sick Leave

Tuition Assistance

Job summary

AvMed, a division of Sentara Health Plans, seeks a Risk Adjustment Nurse/Coder in a hybrid role in Doral, FL. The position focuses on CMS/HHS risk adjustment coding, RADV audits, and ensuring accurate HCC capture in provider documentation.

The ideal candidate holds an associate degree and relevant coding certifications, with 2 years of medical coding experience and familiarity with ICD-10-CM guidelines.

Qualifications

• 2 years of medical coding experience required.
• Thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics.
• One-year previous experience with paper and/or electronic medical records.
• Prefer experience with CMS, HHS and/or RADV risk adjustment concepts.

Responsibilities

• Perform CMS/HHS risk adjustment coding reviews and RADV audits.
• Review professional and inpatient/outpatient coding to ensure HCC capture.
• Conduct annual risk assessments, training, monitoring, auditing, and root cause analysis.
• Oversee vendor quality audits and provide final coding determinations.

Skills

Medical coding experience

ICD-10-CM knowledge

CMS/HHS risk adjustment knowledge

Documentation review

Education

Associate degree in healthcare administration, nursing, health information management, accounting, finance, or related field

Job description

AvMed, a division of Sentara Health Plans, seeks a Risk Adjustment Nurse/Coder in a hybrid role in Doral, FL. The position focuses on CMS/HHS risk adjustment coding, RADV audits, and ensuring accurate HCC capture in provider documentation.

The ideal candidate holds an associate degree and relevant coding certifications, with 2 years of medical coding experience and familiarity with ICD-10-CM guidelines.