Risk Adjustment Coder

143 Sentara Healthcare; United States; Hybrid; USD 71,000 - 109,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401k with employer match

Tuition assistance

Student debt payoff

Job summary

Sentara Health is seeking a Risk Adjustment Coder for a full-time hybrid role in Virginia Beach, VA. The position blends remote and onsite work with 1–2 in-office days weekly and potential site visits.

Responsibilities include CMS/HHS risk adjustment coding, MMR and RADV audits, and reviewing professional and inpatient/outpatient claims to capture diagnoses. Requires Associate degree and 2 years coding experience plus CPC/COC/CIC certifications and CRC within 2 years.

Qualifications

• Associate degree is required.
• Medical Records Data experience: 1 year required.
• Coding experience: 2 years required.
• Must obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment.

Responsibilities

• Performs compliance activities focused on risk adjustment in accordance with CMS and HHS.
• Performs prospective/retrospective medical record reviews and RADV audits.
• Reviews provider coding for professional and inpatient/outpatient services to ensure capture of diagnostic conditions.
• Supports risk adjustment data validation, medical record retrieval, vendor coding audits, and provider engagement.
• Conducts annual risk assessments, training, monitoring, and auditing, and corrective action oversight.

Education

Associate degree

Job description

Risk Adjustment Coder – Full-time Hybrid

Location: Virginia Beach, VA

Work Shift: First (Days)

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 & Experience

Education: Associate degree (Required)

Experience: Medical Records Data – 1 year (Required)

Experience: Coding – 2 years (Required)

Certifications

• 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)


• 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, 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

• 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.

Equal Opportunity Employer

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.

Remote Work Eligibility

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.

Company Overview

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara "Employer of Choice" for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!