AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! This is a full-time permanent position (40 hours) with standard working hours from 8am to 4:30pm EST, Monday to Friday. The position is hybrid, requiring 2 days onsite at AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with CMS and HHS. Responsibilities include prospective/retrospective medical record reviews, CMS/HHS Risk Adjustment Data Validation audits, reviewing provider coding for professional and inpatient/outpatient services, supporting risk adjustment data validation, medical record retrieval, vendor coding audits, provider engagement, and all risk adjustment ICD-10-CM coding-related activities. The role also involves conducting annual risk assessments, training, monitoring, auditing, control assessment, reporting, investigation, root cause analysis, corrective action oversight, vendor quality oversight audits, final coding determination for non-agreeable coding, and serving as a subject matter expert on risk adjustment diagnosis coding guidelines. Coordination of risk adjustment gap elimination with clinical and quality gap elimination is required, along with maintaining fluency in workings and financial implications of applicable risk adjustment models. Education required is an associate degree in healthcare administration, nursing, health information management, accounting, finance, or related field. Certifications required include one of the following: CPC, COC, CIC, CCS-P, CCS, RHIT, or RHIA, with a requirement to obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment. Experience required is 2 years of medical coding or 4 years if no associate degree, thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics, and one year experience with paper and/or electronic medical records. Preferred experience includes one year with risk adjustment programs in a Health Plan or Provider setting, familiarity with CMS, HHS, and/or CDPS+RX HCC models, and CMS and/or HHS RADV experience. AvMed is a not-for-profit health plan with over 50 years of experience, part of Sentara Healthcare, a large integrated healthcare delivery system. The company offers a family-friendly culture, community involvement, and opportunities for development and growth. Benefits include medical, dental, vision plans, adoption/fertility/surrogacy reimbursement, paid time off, parental leave, emergency backup care, disability and critical illness plans, life insurance, 401k/403B with employer match, tuition assistance, student debt pay down, certification reimbursement, pet insurance, legal resources, and potential annual discretionary bonus. Sentara Health is an equal opportunity employer committed to diversity and inclusion and maintains a tobacco-free environment.
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