Schedule : M-F
Shift- 8am-5pm CST/PST
Location : Hybrid , Must be Located in Texas (Dallas-Fort worth), Los Angeles or surrounding areas or Tucson Arizona
TX candidate must travel to 512 W Rosedale ST. Fort Worth 76104 2 days
AZ candidate must travel to 4705 S Landing Way, Tucson, AZ 85714 2 days
CA candidate must travel 3711 S La Brea Ave West, Los Angeles CA, 2 days
Responsible for conducting retrospective medical reviews to assess medical record documentation and monitoring submitted codes on claim/encounters for Medicare Risk Adjustment. Primary duties include, but are not limited to:
- Conducts retrospective medical record and claims review to assess medical record documentation practices and accuracy/sufficiency of policies and procedures.
- Verifies accuracy/appropriateness of submitted diagnosis codes based on medical record documentation looking at both ways 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.
- Identifies and recommends coding best practices to address unsupported additions/deletions, inconsistencies/discrepancies.
- Updates and develops policies and procedures and training/educating collateral to reflect best practices. Conducts on-going review, monitoring and communications to promote and ensure adherence to established protocols and best practices.
- Reviews documentation of well visits (annual well visits and other routine and preventative visits) including the use of appropriate modifiers for HEDIS scoring accuracy.
- Conducts on-going review of medical records/practice notes to validate improvement, identify any new/additional opportunities to improve medical record-keeping, code more accurately, ensure on-going accuracy of submitted codes and accurate risk scoring and continues to verify coding accuracy and completeness to ensure compliance.
Requires minimum of 2 years experience coding all types of medical records (including Medicare Risk Adjustment) in a physician practice setting or large group practice. Current Certified Professional Coder certification (CPC, CPC-H, CCS, or CCS-P) required. Additional experience in procedural clinical coding preferred. Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred.
For the CareMore/Aspire business unit only, the above requirements do not apply. The following are the CareMore/Aspire job requirements for this role:
- Requires a minimum of 2 years’ experience with all types of medical records (including Medicare Risk Adjustment and evaluation and management coding) in a physician practice setting or large group practice, and includes educating providers on clinical documentation needs.
- Certified Clinical Documentation Specialist (CCDS, CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Improvement Professional (CDIP) required.
- Current Certified Professional Coder certification (CPC, CPC-H, CCS, CCS-P or CRC) preferred.
- Additional experience in diagnostic clinical coding preferred.
- Clinical experience or background (e.g. RN, LPN, foreign medical graduates) preferred.
- ISNP experience preferred
- Travel may be required.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $80,976-$101,220
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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 email@example.com for assistance.