Top 4 Risk adjustment coder Jobs in Santa Monica, Ca

Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)
UCLA Health —Los Angeles, CA
- $95,400 - $208,300 a year
- Anatomy knowledge
- Microsoft Outlook
- RN License
Medical Coder/Auditor
Medasource —Long Beach, CA
- $40 - $45 an hour
- Full-time
- Hybrid work
- 5 years
- Travel
- SharePoint
- Health insurance
- Dental insurance
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Medical Coder
Astrana Health, Inc. —Monterey Park, CA
- $22 - $26 an hour
- Email
- Hybrid work
- Research
- Mid-level
- Office
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Risk Adjustment Compliance Auditor (Remote)
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Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)

UCLA Health -
Los Angeles, CA

Apply Now

Job Details

$95,400 - $208,300 a year

Qualifications

Anatomy knowledge
Microsoft Outlook
Clinical compliance checks
Medicare
Health education for healthcare providers
CMS
Word embeddings
HIPAA
Healthcare documentation compliance audits
Medical coding experience in physician offices
Medical coding experience in outpatient clinics
Clinical staff training
Health insurance knowledge
Medicare regulations
Clinical training
Clinical information systems
Clinical documentation
Centers for Medicare & Medicaid Services (CMS) billing regulations
Clinical documentation improvement
Clinical documentation standards
HEDIS
Medical record review for billing accuracy

Full Job Description

Description

As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. You will:

Conduct medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions
Analyze coding patterns within medical groups.
Provide customized education and updating educational materials for providers and medical groups.
Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews.
Travel to provider offices within Los Angeles area at least three days a week.

UCLA Health salary range for this title code is $95,400-208,300/annually. Please note that the department's target pay range is $95,400 - $120,000/annually.

Qualifications

We are seeking a proactive, highly organized, detail-oriented individual with:

Required:

A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification
A Certified Risk Adjustment Coder (CRC)
Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area
Five or more years of experience with physician billing and/or coding
Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28
Three or more years of experience in providing education to clinical and non-clinical staff
Understanding of RADV and audit processes,
Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems
Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications
Knowledge of HIPAA requirements, anatomy and physiology
Proficient in MS Word, Excel, PowerPoint and Outlook
Ability to work effectively with common office software, coding software, and EMR systems
Bachelor’s degree (healthcare or relevant field) or equivalent experience/training

Preferred:

Six or more years of clinic or IPA and/or managed care experience
Knowledge of Medicare Advantage billing/claims submission and other related actions
Ability to work effectively with common office software, coding software, and EMR systems
Registered Nurse (RN) or clinical qualifications

Note: Skills may be subject to test.

Apply Now

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risk adjustment coder jobs in santa monica, ca

Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment (Hybrid)

Medical Coder/Auditor

Medical Coder

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