Remote Risk Adjustment Coder – CMS/HHS RADV

Sentara Health Plans; Virginia Beach (VA); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical plans

Dental plans

Vision plans

401k/403b

Job summary

Sentara Health Plans in Virginia Beach, VA is seeking a Risk Adjustment Coder to perform compliance activities related to CMS/HHS risk adjustment and RADV audits. You will review professional and facility coding to ensure accurate HCC capture and support vendor and internal audits.

The role requires an Associate degree or 4 years of coding experience, knowledge of ICD-10-CM guidelines, and CRC certification within two years.

Qualifications

• Associate degree or 4 years of medical coding experience.
• Thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics.
• One year of paper or electronic medical records experience.
• CRC certification within two years of employment.

Responsibilities

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

Skills

Medical coding

RADV audits

ICD-10-CM

Compliance

Education

Associate degree or 4 years coding experience

Job description

Sentara Health Plans in Virginia Beach, VA is seeking a Risk Adjustment Coder to perform compliance activities related to CMS/HHS risk adjustment and RADV audits. You will review professional and facility coding to ensure accurate HCC capture and support vendor and internal audits.

The role requires an Associate degree or 4 years of coding experience, knowledge of ICD-10-CM guidelines, and CRC certification within two years.