HCC Risk Adjustment Coder

Posted 5 Days Ago
Be an Early Applicant
Hiring Remotely in United States
Remote
Senior level
Artificial Intelligence • Healthtech • Information Technology • Machine Learning • Natural Language Processing • Software • Analytics
Reveleer is a healthcare SaaS that supports health plans & providers gain control over government programs.
The Role
The HCC Risk Adjustment Coder is responsible for reviewing medical records, managing coding accuracy, updating training materials, mentoring staff, and assisting in audits. This role requires maintaining high accuracy in coding projects and adapting to changing priorities while providing guidance in a remote environment.
Summary Generated by Built In

HCC Risk Adjustment Coder (Clinical Operations Specialist)
Remote

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

This is a Full-Time (FT, 40 Hours a week) remote position to perform duties for Risk Adjustment Coding and related Audit initiatives.

Essential Duties and Responsibilities:

  • Review of medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog, larger chart page counts
  • Work population of clinical pends, with goal to clear within 72 hours
  • Updating and maintaining training course material for medical record abstraction and data entry (HEDIS, RISK, IVA)
  • Reviewing training test scores and sending feedback if necessary
  • Assigning and overreading disciplinary charts- (this is a chart move back) all projects
  • Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs)
  • Maintaining an accuracy score of 95% on all work submitted (all projects)
  • Ability to adapt to changing priorities in managing a wide range of projects.
  • Must be able to work independently and in a team environment
  • Remote mentoring/ coaching (for all projects) in a group or 1:1 session with staff and leadership
  • Client trainings (Reveleer technology, if needed)
  • Over read challenges for all projects (reviewing abstractor/coder OR1 feedback challenges)
  • Oversite and coordination of IVA documentation audits: ENR/RXC/ATT/DOB/GEN-
  • Assist in training and successful adoption of Natural Language Processing/” Bot” -assisted coding reviews and relating tools/reporting
  • Reviewing reports for workload assignments, looking at inventory by project to make sure sufficient headcount are assigned per workload (all projects) multi time zone coverage/ shift coverage- evening/ weekends/holidays
  • Managing and addressing questions and clarifications that coders submit to a designated online communication forum and “Q&A” email mailbox while reviewing charts
  • Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
  • Stay up to date with Risk/IVA protocols (coding clinics, coding guidelines)
  • Maintain ongoing communication with Clinical Management team regarding coding workload, turnaround time expectations and deliverables
  • Additional duties as necessary to meet the obligations to our clients

Qualification Requirements:

  • Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS) through AAPC and/or AHIMA.
  • Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC)
  • Additional experience in facility (OPPS/IPPS) coding experience is preferred
  • Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred

Experience and Skills:

  • Ability to work independently in a fast-paced remote environment with minimal supervision and guidance
  • Ability to interact with management and remote coding personnel
  • Possess strong organizational skills and attention to detail
  • Ability to adapt to changing priorities while managing a wide range of projects
  • Adaptive and flexible to new ideas and change
  • Advanced knowledge of medical terminology, anatomy and pharmacology
  • Advanced skills utilizing official coding resources for research and problem solving
  • Advanced skills and knowledge of computers, use of required software to perform job functions
  • Excellent written and communication skills and the ability to explain complex information

What You'll Receive:

  • Competitive pay
  • Medical, Dental and Vision benefits including HSA/FSA
  • 401k with Employer Match
  • 100% paid short term and long-term disability insurance
  • PTO plan and 10 paid company holidays

Hourly Rate: $31.25 / hour

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.

The Company
HQ: Glendale, CA
201 Employees
Hybrid Workplace
Year Founded: 2009

What We Do

Reveleer is a healthcare software and services company that uses Machine Learning and Intelligent Automation technology to empower payers in all lines of business to take control over their Quality Improvement and Risk Adjustment programs. The Reveleer platform enables payers to independently execute and manage every aspect of provider outreach, retrieval, coding, abstraction, and reporting – all under one platform. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer also assists payers with full record retrieval and review services to support financial performance and improved member outcomes.

Why Work With Us

We pride ourselves that the road to achieve our mission comes from our innovative and intelligence systems​.
We equally pride ourselves that all is possible with our people and their expertise​.
Scalability and sustainable start with strong systems and people who understand yesterday for success tomorrow​.
Join us in our growth and expansion phase.

Gallery

Gallery

Similar Jobs

GitLab Logo GitLab

Senior Director, Public Policy

Cloud • Security • Software • Cybersecurity • Automation
Easy Apply
Remote
United States
2050 Employees
212K-397K Annually

Cloudflare Logo Cloudflare

Regional Director Majors, Midwest

Cloud • Information Technology • Security • Software • Cybersecurity
Remote
United States
3900 Employees

Motorola Solutions Logo Motorola Solutions

CommandCentral AWARE System Manager

Artificial Intelligence • Hardware • Information Technology • Security • Software • Cybersecurity • Big Data Analytics
Remote
Florida, USA
21000 Employees

Square Logo Square

Head of Revenue Operations and Enablement

eCommerce • Fintech • Hardware • Payments • Software • Financial Services
Remote
Hybrid
8 Locations
12000 Employees
218K-327K Annually

Similar Companies Hiring

InCommodities Thumbnail
Renewable Energy • Machine Learning • Information Technology • Energy • Automation • Analytics
Austin, TX
234 Employees
RunPod Thumbnail
Software • Infrastructure as a Service (IaaS) • Cloud • Artificial Intelligence
Charlotte, North Carolina
53 Employees
Hedra Thumbnail
Software • News + Entertainment • Marketing Tech • Generative AI • Enterprise Web • Digital Media • Consumer Web
San Francisco, CA
14 Employees

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account