AIMRRA Job Board
Quality, Education Coding Specialist (FEATURED EMPLOYER)
Must have CODER Certification.
Remote position.
About the Role
The Quality, Education & Coding Specialist works collaboratively with clinic and providers for enhancements, training and education for risk adjustment documentation and performs medical record reviews in accordance with HEDIS technical specifications. This position requires demonstrated knowledge, skill and ability to educate, train and advise clinical staff for process improvements.
This position is also responsible for performing quality medical record reviews, assisting providers and staff in the improvement of clinical documentation and workflows, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records.
To be successful in this role, you:
Required:
Possess an Associate’s Degree or an equivalent combination of education and highly relevant experience required.
Have current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA required.
Preferably:
Have current, unrestricted license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) preferably.
Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards to providers and staff.
Provide real-time support for clinical care and HEDIS/Star teams for annual submission.
Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
Maintaining productivity level of a minimum of 50 chases/charts per defined period according to policy.
Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
Other duties as assigned.
Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Knowledge, Skills, and Abilities:
Remote position.
About the Role
The Quality, Education & Coding Specialist works collaboratively with clinic and providers for enhancements, training and education for risk adjustment documentation and performs medical record reviews in accordance with HEDIS technical specifications. This position requires demonstrated knowledge, skill and ability to educate, train and advise clinical staff for process improvements.
This position is also responsible for performing quality medical record reviews, assisting providers and staff in the improvement of clinical documentation and workflows, identifying trends and gaps in care, maintaining accurate records of review activities, ensures all data submitted to the health plan meets HEDIS technical specifications for medical records.
To be successful in this role, you:
Required:
Possess an Associate’s Degree or an equivalent combination of education and highly relevant experience required.
Have current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA required.
Preferably:
Have current, unrestricted license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN) preferably.
- Possess a minimum of three years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC) and/or Chronic Illness and Disability Payment System (CDPS).
- And a minimum of three years working with HEDIS data including chart review/collection. HEDIS, QRS, or STARs experience.
- Have experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred.
- Have clinical knowledge related to chronic illness diagnosis, treatment and management.
- Have experience working with clinical staff for process improvement; ability to provide education and coaching to clinic staff.
- Have experience with Microsoft Office applications, including Word, Excel and PowerPoint.
- Essential functions and Roles and Responsibilities:
- Collaborate, educate and train clinical support staff and providers on risk adjustment documentation and workflows specific to HCC and CDPS models.
- Ensure compliance with internal coding guidelines, department policies, and CMS risk adjustment coding guidelines, rules and regulations. Keep current on regulatory and coding issues/best practices including AHA Coding Clinics and ICD-10 Official Guidelines for Coding and Reporting.
- Audit provider and vendor documentation of ICD-10 codes to ensure adherence with risk adjustment guidelines.
- Perform root cause analysis to identify issues that may contribute to coding, documentation, claims or other revenue cycle deficiencies.
Provide coding support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards to providers and staff.
Provide real-time support for clinical care and HEDIS/Star teams for annual submission.
Maintaining an abstraction proficiency rate of 95% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
Maintaining productivity level of a minimum of 50 chases/charts per defined period according to policy.
Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
Other duties as assigned.
Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Knowledge, Skills, and Abilities:
- Applied understanding of principles of reimbursement based on risk adjustment model(s) including CMS Hierarchical Condition Categories (HCCs) and Chronic Illness and Disability Payment System (CDPS).
- Knowledge of acceptable medical record standards and criteria in the context of risk adjustment data validation (RADV).
- Advanced, applied knowledge of ICD-CM codes, coding conventions and coding guidelines.
- Proficiency with computer business applications, and a working knowledge of electronic medical record (EMR) software.
- Demonstrated ability to educate, coach and advise clinical staff for process improvement and workflow re-design.
- Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
- Demonstrated organizational, time management, and project management skills.
- Strong written and verbal communication skills; able to communicate with and collaborate effectively with physicians and allied health care providers.
- Willingness to be part of a fast moving, and dynamic clinical development team.
- Perform all functions of the job with accuracy, attention to detail and within established timeframes.
- Meet attendance and punctuality standards.
- Strong computer skills and reliable high-speed internet access at home.
- Demonstrate professional courtesy to others and ability to maintain confidentiality.
- Ability to be proactive in problem identification and resolution.
- Ability to work independently.
HEDIS Position - (FEATURED EMPLOYER)
Required
HEDIS/Hybrid Experience
Remote
ASAP to Early May/June 2024 (End of HEDIS Season)
Candidates will work with the HEDIS team to request, review and abstract medical records to support HEDIS/Hybrid season.
Prior HEDIS experience is required.
Ability to work within HEDS documentation systems for Hybrid season
Request, review and abstract medical records as needed.
HEDIS/Hybrid Experience
Remote
ASAP to Early May/June 2024 (End of HEDIS Season)
Candidates will work with the HEDIS team to request, review and abstract medical records to support HEDIS/Hybrid season.
Prior HEDIS experience is required.
Ability to work within HEDS documentation systems for Hybrid season
Request, review and abstract medical records as needed.
SR. ABSTRACTOR, HEDIS/QUALITY IMPROVEMENT
Our Client is seeking a Sr. Abstractor conducts data collection and abstraction of medical records for HEDIS projects, HEDIS like projects and supplemental data collection.
Must have moderate knowledge of how to use a laptop computer and smart phone.
The abstraction team will meet chart abstraction productivity standards as well as minimum over read standards. Sr. Abstractors will also provide mentoring to entry level abstractors.
Job Duties
- Performs the coordination and preparation of the HEDIS medical record review which includes ongoing review of records submitted by providers and the annual HEDIS medical record review.
- Participates in meetings with vendors for the medical record collection process.
- As needed, may collects medical records and reports from provider offices, loads data into the HEDIS application, and compares the documentation in the medical record to specifications to determine if preventive and diagnostic services have been correctly performed.
- Participates in scheduled meetings with the Over read team, Training Team, HEDIS team, vendors and HEDIS auditors regarding quality and HEDIS review and results.
- Assists with projects and process improvement initiatives
- Mentors/Educate/Train entry level Abstractors
Must have moderate knowledge of how to use a laptop computer and smart phone.
HEDIS Auditor - Remote, Multiple States, USA
Various, Multiple States, United States of America
Qualifications & Requirements:
Retrieve and review specific requested documentation from medical records.
Scan relevant components of the medical record to support reviews performed and upload all scanned medical records daily
Maintain lines of communication with the assigned clinical lead, project coordinator and project manager
Successfully complete required training, testing and quality assessments
Communicate effectively and professionally with office managers, health systems and any other facility or care providers
Schedule and confirm all appointments based on your independent assignment for efficiency
Abide by all HIPAA and Independence patient confidentiality requirements
Qualifications & Requirements:
- Chart auditing/abstraction experience with HEDIS
- Experience scheduling office appointments and traveling to physician offices, experience working for Health plans required.
- Flexibility to travel to areas when needed.
- EMR/EHR experience.
- Certified Coder credentials (CPC, CCS) CRC or CHRR certification preferred.
Must have moderate knowledge of how to use a laptop computer and smart phone.
Computer equipment, encrypted zip drives and mobile phones is provided for uploading, transferring and scanning files to our secure file transfer site.
Clinical Specialist - (Prefer Nurse + CRC Coder)
Our Client is seeking a Clinical Specialist - Coder that can support clients transitioning to value-based programs and troubleshoots lagging performance by assisting in removing barriers. The Clinical Specialist is a nurse and certified risk adjustment coder. They serve as an advisor and consultant on coding initiatives for internal and external stakeholders. This individual will create and review clinical content related to coding, perform coding audits for select clients, and train clients on accurate and complete coding.
Job Responsibilities: To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned.
Audit accuracy, quality, and consistency of coded data by conducting audits of medical records, practice management systems, billing systems, and computer databases related to Medicare reimbursement.
Serve as a subject matter expert on topics such as CMS risk adjustment coding, Hierarchical Condition Category (HCC) coding, best practices, and medical record review criteria.
Train and facilitate educational events related to best practices in coding for audiences, including primary care physicians, nursing staff, administrators, coders, and billers.
Coordinate with Delivery Team, Content Team & Product Team to develop, integrate, and maintain clinical coding content into our Approved Content library and Platform product functionality.
Verify compliance with federal, state, and local laws, especially regarding Medicare coding and documentation guidelines. Synthesize complex information from multiple, sometimes conflicting, sources to form a conclusion.
Education content inquiries and provide training for internal and external staff.
Qualifications/Requirements
Qualifications
Job Responsibilities: To perform this job successfully, an individual must be able to perform the following satisfactorily; other duties may be assigned.
Audit accuracy, quality, and consistency of coded data by conducting audits of medical records, practice management systems, billing systems, and computer databases related to Medicare reimbursement.
Serve as a subject matter expert on topics such as CMS risk adjustment coding, Hierarchical Condition Category (HCC) coding, best practices, and medical record review criteria.
Train and facilitate educational events related to best practices in coding for audiences, including primary care physicians, nursing staff, administrators, coders, and billers.
Coordinate with Delivery Team, Content Team & Product Team to develop, integrate, and maintain clinical coding content into our Approved Content library and Platform product functionality.
Verify compliance with federal, state, and local laws, especially regarding Medicare coding and documentation guidelines. Synthesize complex information from multiple, sometimes conflicting, sources to form a conclusion.
Education content inquiries and provide training for internal and external staff.
Qualifications/Requirements
- Proficient and knowledgeable in ICD-10, CPT, HCPCS, and HCC Coding.
- Demonstrates ability to provide training on documentation & coding in a way that engages multiple learners (physicians, nurses, medical assistants, practice administrators, office staff).
- The ability to evaluate medical records with attention to detail and to summarize findings.
- Excels in public speaking and client engagement.
- Ability to collaborate and meet demands.
- Proficient planning and organizational skills.
- Calm and effective in a high-pressure, fast-paced, client-driven environment.
- Self-motivated and able to work independently and collaborate in a virtual environment while managing multiple deliverables with competing priorities.
Qualifications
- LPN or RN or equivalent degree.
- Certified Coder credentials (CPC, CCS) CRC or CHRR certification preferred.
- Experienced working with ACO- Accountable Care Organizations.
Quality Improvement Specialist
AIMRRA is a partner with a healthcare organization, that works and developing strong relationships with assigned provider groups and delivering time sensitive reporting for HEDIS care gap closure and Supplementary Data.
Educating providers on proper coding and gap closure.
HEDIS record collection, data entry and overreading of records during “chart chase season” which measures our plan performance.
Ensuring other time sensitive reporting is sent to providers within a timely manner.
- Educating providers to assist in score improvement year over year.
- Supplementary Data
- HEDIS chart retrieval, data entry and overreading of charts.
- Must hold a one or more certification - CRC / CHRR / CMRC / CPC
HEDIS Auditor - North Carolina, Multiple States, USA
AIMRRA is currently seeking HEDIS Reviewers to work REMOTE FROM HOME
Requirements:
Must have moderate knowledge of how to use a laptop computer and smart phone.
Various, Multiple States, North Carolina, United States of America
This job will have the following responsibilities: (supplementary data)
- Retrieve and review specific requested documentation from medical records.
- Scan relevant components of the medical record to support reviews performed and upload all scanned medical records daily
- Maintain lines of communication with the assigned clinical lead, project coordinator and project manager
- Successfully complete required training, testing and quality assessments
- Communicate effectively and professionally with office managers, health systems and any other facility or care providers
- Schedule and confirm all appointments based on your independent assignment for efficiency
- Abide by all HIPAA and Independence patient confidentiality requirements
Requirements:
- Chart auditing/abstraction experience with HEDIS
- Experience scheduling office appointments and traveling to physician offices, experience working for Health plans required.
- Flexibility to travel to areas when needed.
- EMR/EHR experience.
Must have moderate knowledge of how to use a laptop computer and smart phone.
Computer equipment, encrypted zip drives and mobile phones is provided for uploading, transferring and scanning files to our secure file transfer site.
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980-990-4056
info@aimrra.org
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