Description
CareMore is a proud member of the Elevance Health family of brands, offering clinical programs and primary care. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.
*CANDIDATE MUST RESIDE WITHIN EITHER LOS ANGELES COUNTY OR ORANGE COUNTY, CALIFORNIA.
Location: Hybrid Role - Traveling to a CareMore Care Center/Provider’s office within Los Angeles County, CA will be required.
The Risk Adj & Coding Ld is responsible for leading a team of coders in the identification, collection and assessment of claim/encounter information as it pertains to CMS guidelines, conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment.
How will you make an impact:
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Lead Risk Adjustment operations including provider education, data analysis, audits and overseeing record request process.
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Ensure compliance with mandated and corporate policies.
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Conduct prospective, concurrent, and retrospective medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures.
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Verify accuracy/appropriateness of submitted diagnosis codes based on medical record documentation looking at 1) appropriate detail in the medical record is not captured in what is reported, and 2) when reported information is not supported by details in the medical record.
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Identify and educate on compliant documentation and coding best practices to address unsupported additions/deletions, inconsistencies/discrepancies.
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Update and develop policies and procedures and training/educating material to reflect best practices.
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Conduct ongoing review, monitor and communication with assigned clinicians to promote and ensure adherence to established protocols and best practices.
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Review documentation of well visits (annual well visits and other routine and preventative visits) including the use of appropriate modifiers for HEDIS scoring accuracy.
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Conduct on-going review of encounter notes to monitor for performance improvement and identify new opportunities for education and training.
Minimum Requirements:
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Requires BA/BS in health care or business and minimum of 2 years’ experience in the healthcare industry and expertise in Risk Adjustment ; or any combination of education and experience, which would provide an equivalent background.
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AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management Association) coding certification or equivalent certification required .
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Local travel will be required.
Preferred Skills, Capabilities and Experiences:
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2 years of experience coding all types of medical records (including Medicare Risk Adjustment) in a physician practice setting or large group practice.
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Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO) strongly preferred
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Current Certified Professional Coder certification (CPC, CPC-H, CRC, CCS, or CCS-P)
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Additional experience in procedural clinical coding preferred.
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Clinical experience or background (e.g., RN, LPN, foreign medical graduates).
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $85,192 to $127,788
Location: California
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.