Of Position: Coordinates the clinical coding staff and oversees the chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for both Medicare and ACA services. Works collaboratively with clinical team and management in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Coordinates clinical activities associated with the Risk Adjustment Data Validations (RADV) audits as well as se... more details
Coordinator - Coding Audit
SummaCare - 1200 E Market St, Akron, OH
Full-Time / 40 Hours / Days (Monday - Friday)
Remote
SummaCare is a Summa Health entity that offers health insurance in northern Ohio. As a regional, provider-owned health plan, SummaCare is based in Akron, Ohio, and provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2024 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.
Summary of Position:
Coordinates the clinical coding staff and oversees the chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for both Medicare and ACA services. Works collaboratively with clinical team and management in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Coordinates clinical activities associated with the Risk Adjustment Data Validations (RADV) audits as well as serving as the principal CMS liaison for coding questions/issues. Leads the clinical team in determining the adequacy and accuracy of physician diagnosis/documentation as it relates to risk adjustment.
Formal Education Required: a. Associate degree or equivalent combination of education and/or experience. b. Certified Risk Adjustment Certification (CRC) or Certified Professional Coder (CPC) from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) equivalent.
2. Experience & Training Required: a. Five (5) years of experience that has provided leadership skills to include, delegating tasks, overseeing medical chart reviews, and/or risk adjustment processes which has provided along with an in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding.
3. Other Skills, Competencies and Qualifications: a. Demonstrate strong attention to detail and understanding the medical record in order to determine the appropriate health conditions (correct diagnosis codes) that should be submitted as additions or redactions for risk adjustment. b. Ability to maintain confidentiality of patient and business information. c. Demonstrate knowledge of Microsoft Office suite and other software for electronic processing of medical records. d. Flexible: ability to adjust work hours to meet business demands.
4. Level of Physical Demands: a. Sit for prolonged periods. b. Bend, stoop, and stretch. c. Lift up to 20 pounds. d. Manual dexterity to operate computer, phone, and standard office machines.
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