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Risk Adjustment Coding Consultant
InnovaCare Health

Location: Miami, Florida
Work Setting: Other
Job Function:
Auditor, CDI Specialist, Coder, Coding – QA, Coding – Auditor, Educator
Job Type:
Full-Time

Introduction

The Risk Adjustment Coding Consultant (RACC) serves as subject matter expert in diagnostic coding and RAF methodology. His or her performance ensures diagnostic coding accuracy and compliance for each plan’s member. The RACC possesses an excellent ability to work directly with provider’s medical staff, physicians, and targeted groups using educational material, presentations, key performance indicator reports and other tools. The RACC works on-site with plan’s network and may be required to travel around different locations and states.

Job Description

  • Analyze the risk adjustment and other data based on diagnoses, medical services, codes, and other indicators for identifying opportunities for improvements.
  • Review medical documents such as surgical reports, medical visits, and diagnostic reports in order to create educational strategies to ensure correct diagnosis code assignment by the provider.
  • Review clinical documentation and assign accurate diagnosis codes according to guidelines and projects
  • Perform coding compliance audits.
  • Be able to identify opportunities in diagnosis coding, clinical documentation and billing within the provider’s day-to-day operations.
  • Performs on-going educational interventions to providers to close gaps or related data
  • Deliver training to physicians, targeted groups and administrative staff regarding coding topics.
  • Maintains a log of audits and education performed of diagnosis/HCC gaps.
  • Prepares and submits to the supervisor a monthly report of activities performed.
  • Participates in training to maintain understanding of CMS regulations
  • Performs other duties relevant to the position.

Required Qualifications

At least two years of experience working with healthcare providers such as physicians, MSO, hospitals and others.

Preferred Qualifications

Educational requirements:

  • Associates or (preferred) Bachelor’s Degree of Science in health information management, health informatics, biology, nursing, business administration or related to the health industry from an accredited school.

Professional certifications and experience

  • Certificated coder with at least 1 year of experience in medical coding, medical billing, medical record reviewing, drug or provider representative experience. Recognized certifications by the American Academy of Professional Coders (AAPC) or American Health Information Management (AHIMA) or Association of Clinical Documentation Improvement Specialists (ACDIS). These are: CRC, CPC, CIC, COC, CPC-P, CPMA, CDEO, CCS, CCS-P, CDIP, RHIA, RHIT, CCDS, or CCDS-O.
  • Or certified medical assistant (MA) or registered nurse (RN) in FL with an active license and at least 1 year of medical coding, medical billing, medical record reviewing, drug or provider representative experience.
  • Or at least 4 years of experience in medical coding, medical billing, medical record reviewing, drug or provider representative experience.

Education Qualifications

Associates or (preferred) Bachelor’s Degree of Science in health information management, health informatics, biology, nursing, business administration or related to the health industry from an accredited school.

Instructions for Resume Submission

Submit your resume or any question to: gabriel.aponte@mmm-fl.com

Posted: February 28, 2019 at 5:17 PM
Post ID: 36908

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