Risk Adjustment Coder

sentara; United States; Hybrid; USD 71,000 - 109,000; Full time

Benefits offered by this job

Medical benefits

Dental insurance

Vision plans

401k with employer match

Tuition assistance

Student debt payoff

Pet insurance

Job summary

Sentara Medical Group is hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA. The role involves reviewing medical records for CMS/HHS risk adjustment and performing RADV audits, with in-office presence 1–2 days per week or site visits as needed.

Qualifications include an Associate degree and 1 year of Medical Records Data experience, 2 years of coding experience, and certification requirements with CRC to be obtained within two years.

Qualifications

• Medical Records Data experience (1 year) required.
• Coding experience (2 years) required.
• Certifications in CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA or CRC to be obtained within 2 years.

Responsibilities

• Perform CMS/HHS risk adjustment coding for professional and inpatient/outpatient services.
• Conduct prospective/retrospective medical record reviews and RADV audits.
• Provide subject matter expertise on risk adjustment coding guidelines and documentation gaps.
• Coordinate risk adjustment gap elimination with clinical and quality teams.

Education

Associate degree

Tools

ICD-10-CM coding

CMS/HHS RADV

Job description

City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Medical Group is now hiring a full-time hybrid Risk Adjustment Coder in Virginia Beach, VA!

Hours: Monday - Friday, dayshift.

This is a hybrid position that offers a combination of remote and onsite work, with a requirement to be in the office one to two days each week or must be able to do site visits. The role also includes travel as needed to support business objectives and team collaboration.

Overview

Performs compliance activities focused on risk adjustment in accordance with Centers for Medicare & Medicaid Services (CMS) and U.S. Department of Health & Human Services (HHS). Performs prospective/retrospective medical record reviews (MMR) & CMS/HHS Risk Adjustment Data Validation (RADV) audits. Reviews provider coding for professional & inpatient/outpatient services to ensure capture of diagnostic conditions supported within the provider's documentation for CMS/HHS Hierarchical Condition Categories (HCC). Supports risk adjustment data validation (RADV), medical record retrieval, vendor coding audits, provider engagement, & all risk adjustment ICD-10-CM coding-related activities. Conducts annual risk assessments, training, monitoring, & auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. Performs vendor quality oversight audits; reviews and/or makes final coding determination for non-agreeable coding. Makes final decision on vendor-to-vendor diagnosis coding rebuttal concerns. Serves as subject matter expert on risk adjustment diagnosis coding guidelines. Coordinates risk adjustment gap elimination with clinical and quality gap elimination Maintains a reasonable fluency in workings & financial implications of applicable risk adjustment models.

Education

Associate degree ( Required )

Experience

• Medical Records Data - 1 year ( Required )
• Coding - 2 years ( Required )

Certifications

One of the following certifications are required: Certified Professional Coder ( CPC ), Certified Outpatient Coder ( COC ), Certified Inpatient Coder ( CIC ), Certified Coding Specialist-Physician-based ( CCS-P ), Certified Coding Specialist ( CCS ), Registered Health Information Technician ( RHIT ), or Registered Health Information Administrator ( RHIA ).

Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.

Compensation

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $71,177.60 - $108,534.40 annually.

Additional compensation may be available for this role, such as shift differentials, standby/on-call pay, overtime, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually.

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.