Hybrid Risk Adjustment Nurse/Coder (RN/CPC) - Impact Growth

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

Benefits offered by this job

Medical, dental, vision insurance

401(k) with employer match

Paid time off

Job summary

AvMed, a division of Sentara Health Plans, seeks a Risk Adjustment Nurse/Coder (RN/CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA) to join the hybrid Doral, FL team. The role focuses on risk adjustment coding and CMS/HHS guidelines, with activity spanning medical record reviews and RADV audits.

Qualifications include an associate degree and relevant certifications, plus 2 years of coding experience or 4 years without a degree. Competitive benefits offered, with a base salary range disclosed.

Qualifications

• 2 years of medical coding experience or 4 years without an associate's degree.
• Thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics.
• Experience with RADV and risk adjustment models preferred.

Responsibilities

• Perform compliance activities focused on risk adjustment per CMS/HHS requirements.
• Conduct prospective/retrospective medical record reviews and RADV audits.
• Review provider coding for professional and inpatient/outpatient services to ensure CMS/HCC capture.
• Coordinate risk adjustment gap elimination with clinical and quality teams; mentor on coding guidelines.

Skills

Medical coding

CMS/HHS guidelines

ICD-10-CM knowledge

Education

Associate degree

Job description

AvMed, a division of Sentara Health Plans, seeks a Risk Adjustment Nurse/Coder (RN/CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA) to join the hybrid Doral, FL team. The role focuses on risk adjustment coding and CMS/HHS guidelines, with activity spanning medical record reviews and RADV audits.

Qualifications include an associate degree and relevant certifications, plus 2 years of coding experience or 4 years without a degree. Competitive benefits offered, with a base salary range disclosed.