Certified Risk Adjustment Coder, RN (Remote)

Overview

Quality Reviewer/Auditor will be responsible for establishing and administering the Quality Assurance Programs in Risk Adjustment for internal coders and external vendor coders.

Responsibilities

• The Auditor will develop and lead the risk adjustment coding audit processes. Functions of this role include reviewing samples of coding performed by all coding staff, providing feedback, and identification of trends for education opportunities.
• The Auditor will partner with the Risk Adjustment Team to ensure training programs effectively prepare staff to successfully meet departmental quality standards, as well as assisting to train new staff upon joining the Risk Adjustment Coding team.
• The Auditor will also assist with tracking and trending quality review results to identify common quality errors at the coder level and the team level.
• The Auditor will support coding research projects, assist with daily coding as needed, and work closely with the Risk Adjustment Team to track and trend coding and documentation issues, develop targeted provider education, and create best practices for medical record review and diagnosis code abstraction.

Qualifications

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  Licensure
  
  License and current registration to practice as a registered professional nurse preferably in New York State required. Valid driver's license or NYS Non-Driver photo ID card, may be required as determined by operational/regional needs.
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  Education
  
  Bachelors' degree in health care administration, human services or business administration or related discipline or the equivalent work experience in a related professional field required.
• CCS (Certified Coding Specialist), CPC (Certified Coding Professional), or CIC (Certified Inpatient Coder) required. Certified Risk Adjustment Coder (CRC) required.
• Minimum three years in an HMO, Managed Care Organization or in a health care setting is required.
• Minimum three years of experience reviewing records and accurately applying ICD-10-CM diagnosis codes.
• Experience performing quality reviews or related activities required. Experience working with Microsoft Word, Excel, Outlook and PowerPoint is required.
• Demonstrated ability to build and maintain positive relationships at all levels in the organization.
• Demonstrated ability to present information in an effective manner.
• Demonstrated ability to apply time management methodologies to organizational challenges.
• Demonstrated ability to pro-actively identify problems, as well as recommend and/or implement effective solutions. Demonstrated ability to work with and maintain confidential information.
• Excellent verbal and written communication skills.
• Flexibility to adapt to a changing and fast-paced environment.