OTHER

FEED

UNKNOWN

The Risk Adjustment Coder will offer summarized content, feedback from providers, key barriers or success efforts to executive leaders to assist in the overall risk adjustment of the population. The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records.

Job Details:
Physician Office | Kettering | Full-Time | First Shift

Responsibilities & Requirements:
 Responsibilities & RequirementsThis position under the direction of the Manager of Professional Services Coding is responsible for coding compliance, HCC capture and EPIC WQ Reconciliation.  KPN Pro Fee Coding SpecialistServes as the subject matter expert ensuring coding compliance, knowledge of CMS billing rules and regulations and serves as a professional fee coding resource to network service lines.<ul><li>Demonstrates knowledge of CPT, HCPCS, ICD-10 and CMS NCCI edits</li><li>Reviewing the ambulatory records for the appropriate risk adjustment components</li><li>Identify opportunities for the provider to have supplemental documentation to support the Hierarchical Condition Category (HCC) codes</li><li>Accurately assess documentation in EPIC EMR to assign appropriate CPT, HCPCS and ICD-10</li><li>Reviews and researches pending and denied claims pertaining to professional fee coding, CMS NCCI edits, and/or medical necessity requirements [CMS LDC/NCD and/or payer policy]</li><li>Demonstrate initiative for maintaining current knowledge of CPT, ICD-10 and CMS NCCI edits</li><li>Corresponds with providers on pending claims to facilitate resolution</li><li>Responsible for participating in departmental goals, KHN mission and implemented KHN/KPN policies</li><li>Communicate appropriately with providers, leaders, and staff</li><li>Researches and resolves concerns timely</li></ul> The Risk Adjustment Coder is responsible for coding and abstracting all outpatient patient records using ICD-10-CM and CPT/HCPCS coding rules, federal guideline and KMCN guidelines. Additionally, the Risk Adjustment Coder supports hospital’s accounts receivable goals through timely processing of records and physician record completion activities. Impacts delivery of quality patient care and enhanced clinical decision-making process. Supports clinical outcomes measurement and assessment process for service lines. Completes assigned duties and other related tasks. The list is not inclusive, Performs other duties as assigned.  The Risk Adjustment Coder will supplement the educational offerings of the MSO by providing right-time feedback to providers when documenting or coding the risk adjustment on patient records.  The Risk Adjustment Coder will contribute to overarching educational efforts of the MSO regarding Risk Adjustment.  The Risk Adjustment Coder will offer summarized content, feedback from providers, key barriers or success efforts to executive leaders to assist in the overall risk adjustment of the population.  The Risk Adjustment Coder will spend some in-person time with providers to foster a relationship and encourage dialogue with risk adjustment to improve overall outcomes. The Risk Adjustment Coder will develop a collegial relationship with the Clinical Documentation Specialist RN (CDS) to partner on the overarching risk adjustment of the population. Educational Requirements:High School Diploma or equivalentRHIT, RHIA, CCS, CCS-P, CPC or eligible specialty certificationPrior experience in professional fee coding/billingCRC required within 1 year of hire

Overview:
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Our mission is to live God’s love by promoting and restoring health. Our commitment to our patients is to help individuals be their best. With that context, safety is our top priority. We provide an integrated system of healthcare experts committed to providing exceptional care.

Kettering Health

Risk Adjustment Coder - Risk Management

Accounts Receivable

Billing

Centers for Medicare and Medicaid Services (CMS)

Clinical Outcomes

Clinical Study Publications

Clinical Support

Content Management Systems (CMS)

Current Procedural Terminology (CPT)

Documentation

Healthcare

Healthcare Common Procedure Coding System (HCPCS)

Hospital

ICD-10

Maintain Compliance

Medical Coding

Medical Office

Medical Records

Medical Writing

Nonprofit

Outpatient Care

Patient Care

Professional Services

Reconciliation

Registered Nurse (RN)

Regulations

Risk

Risk Management

Support Documentation

Time Management

[AW]-iCims

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

YEAR

Overview:
Nurse Practitioner Per DiemThis position covers all zip codes in: Montgomery County, OH ComplexCare Solutions (CCS) specializes in helping those in need by delivering high-value home and virtual assessments for health plans nationwide. We pride ourselves on our member engagement aimed towards evaluating current health status, gaps in care, potential health risks and care management opportunities with a focus on driving better clinical outcomes. CCS, on behalf of SME Medical Delaware, P.A., is calling on Advanced Practice Providers that are passionate about helping their local communities. We care dearly about those whom we serve, and we need your help to make a difference in the lives of our members. Providers have the opportunity to spend a full hour with these members, which allows them to capture a comprehensive picture of that individual’s personal needs and what is required to keep them in the home and out of the hospital. <div class="x_x_elementToProof">Compensation:<ul><li style="margin:0in">Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income</li><li style="margin:0in">In-home visit rate: $120 - $140 depending on state of residence</li><li style="margin:0in">If available, our telehealth rate is $85 per completed assessment</li></ul></div>Benefit:This position is eligible to participate in a company 401K plan providing the opportunity to save for retirement through employee contributions. New hires will be automatically enrolled in the company 401(k) plan at a 3% contribution rate with the option to opt out.

Responsibilities:
<ul><li>Knowledge of CMS Regulations and NCQA HEDIS Guidelines</li><li>Knowledge of Evidence-based Clinical Practice Standards: American Diabetes Association (ADA), American College of Cardiology (ACC), American Heart Association (AHA), Familiarity with ICD-10 and CPT-4 coding practices</li><li>Complete comprehensive, accurate and thorough review of the assigned member population, including timely completion and submission of all required encounter documentation (paper or electronic)</li><li>Ensure that all pertinent and active medical conditions are documented in the medical record in a manner compliant with CMS/DHHS, Company policy, and client requirements</li><li>Support the physician/patient relationship and ensure timely and adequate communication, documentation of assessment findings, recommendations, need for additional services, emergency services required if necessary and need for follow up and timelines for follow up to primary care provider (PCP) and health plan as required</li><li>Make general recommendations to members intended to improve members' knowledge of their chronic condition(s), such as information concerning recommended testing</li><li>Address and close identified gaps in care (disease-specific or preventive)</li><li>Recognize emergent or urgent situations requiring escalation and take appropriate action as specified in company policies, and as determined by reasonable professional judgment and ethical professional practice standards; and</li><li>Perform, document and communicate results of Point of Care (POC) Testing</li><li>Maintain compliance with Company policies, procedures and mission statement</li><li>Adhere to all confidentiality and HIPAA requirements as outlined within the Company’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position</li><li>Fulfill those responsibilities and/or duties that may be reasonably provided for the purpose of achieving operational and financial success of the Company</li><li>Uphold responsibilities relative to the separation of duties for applicable processes and procedures within your job function</li><li>On a monthly basis, be available for a minimum of 25 slots of availability per month (approximately 37 hours)</li><li>We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such</li><li>Other duties as assigned</li></ul>

Qualifications:
<ul style="margin-top:0in"><li>Active un-encumbered license to practice nursing</li><li>ANCC or AANP board certification as a Nurse Practitioner or Clinical Nurse Specialist in Family, Adult, Gerontology or Emergency Medicine. </li><li>Maintains current CPR certification</li><li>Compliance, prior to hire, with recommended Healthcare Personnel Requirements for vaccinations and preventive testing:</li><li><ul style="margin-top:0in"><li>Hepatitis B</li><li>Influenza</li><li>MMR: Measles, Mumps and Rubella</li><li>Pertussis, Tetanus and diphtheria and acellular pertussis (Tdap)</li><li>Varicella</li><li>Tuberculosis</li></ul></li><li>Home Health exp a plus </li><li>Must be able to effectively communicate with elderly and chronically ill patients and families</li><li>Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial</li><li>Ability to multitask</li><li>Excellent customer service skills</li><li>Bi-lingual or multi-lingual a plus</li><li>Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision</li><li>Proficient with computer platforms, electronic health records (EHRs), secure messaging systems, and cloud-based documentation tools</li></ul>This company utilizes E-Verify. ComplexCare Solutions (CCS) is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. By embracing diversity, equity and inclusion we enhance our work environment and drive business success. ComplexCare Solutions (CCS) strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

ComplexCare Solutions

Nurse Practitioner (Per Diem)

American Nurses Credentialing Center (ANCC)

CPR Certification

Cardiology

Certified Coding Specialist (CCS)

Clinical Nursing

Clinical Practices/Protocols

Cloud Computing

Communication Skills

Computer Skills

Computer Systems

Corporate Policies

Customer Support/Service

Department of Health and Human Services

Diabetes

Disease

Diversity

Emergency Medicine

Emergency Services

Equal Employment Opportunity (EEO)

HIPAA (Health Insurance Portability and Accountability Act)

Health Plan

Healthcare Effectiveness Data and Information Set (HEDIS)

Hepatitis B

Home Care

Medicaid

Medical Conditions

Medical Record System

Medicare

Messaging Technology

Multilingual

Multitasking

National Committee for Quality Assurance (NCQA)

Nurse Practitioner

Nursing Credentials

Operations Processes

Patient Assessment

Primary Care

Staff Requirements

Telehealth

Treatment Plan

For the past forty-five plus years, we have supported Department of Defense customers by developing innovative remote sensing algorithms, tools, and techniques to deliver world-class data exploitation capabilities supporting missile defense; intelligence, surveillance, & reconnaissance; space domain awareness; and aircraft survivability missions. The ideal candidate is a strong individual contributor with deep Configuration as Code (CaC), Infrastructure as Code (IaC), and Kubernetes expertise ready to make a real impact and solve complex challenges with passion.

SciTec, a wholly owned subsidiary of Firefly Aerospace, is a dynamic non-traditional defense contractor that delivers advanced technologies in support of U.S. National Security and Defense. For the past forty-five plus years, we have supported Department of Defense customers by developing innovative remote sensing algorithms, tools, and techniques to deliver world-class data exploitation capabilities supporting missile defense; intelligence, surveillance, & reconnaissance; space domain awareness; and aircraft survivability missions.Important Notice: SciTec exclusively works on U.S. government contracts that require U.S. citizenship for all employees. SciTec cannot sponsor or assume sponsorship of employee work visas of any type. Further, U.S. citizenship is a requirement to obtain and keep a security clearance. Applicants that do not meet these requirements will not be considered.We are seeking a Senior Staff / Senior DevSecOps Engineer to design, develop, and sustain high-quality CI/CD pipelines, containerize applications, and deploy cloud-based platforms. This role focuses on distributed systems, microservices, and real-time data pipelines, working closely with scientific and technical users in a mission-focused environment.The ideal candidate is a strong individual contributor with deep Configuration as Code (CaC), Infrastructure as Code (IaC), and Kubernetes expertise ready to make a real impact and solve complex challenges with passion. Key Responsibilities<ul><li>Design, maintain, and improve CI pipelines (GitLab CI) for secure software builds and deployments</li><li>Orchestrate automated deployments across development, test, and production environments using Kubernetes and Helm</li><li>Ability to perform tasks well aligned with team and product goals with limited technical oversight and guidance.</li><li>Provide thought leadership, mentorship, and input into tasks for projects</li><li>Integrate CI pipelines with tools for artifact management, testing, code quality, and security scanning</li><li>Monitor and troubleshoot CI/CD pipeline performance and deployment issues</li><li>Manage software release processes including version promotion, branching, integration, and validation</li><li>Maintain and implement Helm charts for application deployments</li><li>Perform deployment validation and issue resolution in Kubernetes-based environments</li><li>Ensure adherence to cybersecurity protocols and secure coding practices</li><li>Support software vulnerability scanning (Static & Dynamic Analysis Tools) and remediation processes</li><li>Perform other DevSecOps-related duties as assigned</li></ul>RequirementsThe following minimum qualifications are required for the position:<ul><li>Bachelor’s degree in Information Technology, Computer Science, or related technical field</li><li>5+ years of DevOps engineering, system administration and infrastructure management</li><li>Container orchestration with tools such as Docker, Kubernetes, Kustomize, or Helm</li><li>2+ years of experience with Infrastructure as Code tooling (Terraform, CloudFormation, Ansible, etc.)</li><li>Proven ability to automate complex workflows and processes</li><li>Design systems to maximize ability to audit and observe</li><li>Demonstrated ability to collaborate effectively across technical disciplines</li><li>Strong attention to detail and commitment to high-quality, well-tested code</li><li>Excellent verbal and written communication skills</li><li>Professional experience working in Linux environments</li><li>Experience using version control systems such as Git</li><li>Ability to obtain and maintain a DoD security clearance</li></ul>Candidates who have any of the following skills will be preferred:<ul><li>Advanced degree (e.g., Masters, PhD) in Computer Science or Engineering</li><li>Advanced Security Credentials: Active IAT Level III certification (e.g., CISSP, CASP+, or SecurityX).</li><li>Linux systems administration</li><li>Container security tools (e.g., Grype, Syft)</li><li>SAST/SCA tools (e.g., Fortify, SonarQube, Snyk, Trivy, ZAP)</li><li>AWS (EKS, EC2, Lambda)</li><li>Application networking with tools such as Istio, NGINX, or Traefik</li><li>Monitoring and observability tools (e.g., Prometheus, Grafana)</li><li>Authentication tools (e.g., Keycloak)</li><li>Artifact repositories (e.g., JFrog Artifactory, Nexus)</li><li>Additional programming experience with strongly typed languages such as C++ or Rust</li><li>Familiarity with secure software development and vulnerability management workflows</li><li>Experience supporting RMF processes, ATO activities, or DISA STIG application</li><li>Active DoD Top Secret security clearance</li></ul>*Resumes, Cover Letters, and Applications which are generated by AI will not be considered for employment.BenefitsSciTec offers a highly competitive salary and benefits package, including:<ul><li>4% Safe Harbor 401(k) match</li><li>100% company paid HSA Medical insurance, with a choice of 2 buy-up options</li><li>80% company paid Dental insurance</li><li>100% company paid Vision insurance</li><li>100% company paid Life insurance</li><li>100% company paid Long-term Disability insurance</li><li>Short-term Disability insurance</li><li>Annual Profit-Sharing Plan</li><li>Discretionary Performance Bonus</li><li>Paid Parental Leave</li><li>Generous Paid Time Off, including Holiday, Vacation, and Sick Pay</li><li>Flexible Work Hours</li></ul>The pay range for this position is $111,000-$152,000. SciTec considers several factors when extending an offer of employment, including but not limited to the role and associated responsibilities, a candidate's work experience, education/training, and key skills. This is not a guarantee of compensation.SciTec is proud to be an Equal Opportunity employer. Vet/Disabled.

SciTec

Sr. Staff / Senior DevSecOps Engineer

Aerospace and Defense

Algorithms

Ansible

Authentication

Build Management

C++ Programming Language

CISSP - Certified Information Systems Security Professional

Cloud Applications

Computer Engineering

Computer Science

Computer Security

Continuous Deployment/Delivery

Continuous Integration

Data Management

Defense Information Systems Agency (DISA)

Detail Oriented

DevOps

Disability Insurance

Distributed Computing

DoD Clearance

Docker

Dynamic Analysis

Government Contracts

Health Insurance

IAT - Information Assurance Technical

Identify Issues

Information Technology & Information Systems

Internet Security

Linux Administration

Linux Operating System

Machine Tool

Mentoring

Microservices

Presentation/Verbal Skills

Problem Solving Skills

Process Management

Production Systems

Release Management/Engineering

Secure Coding

Security Clearance

Security Protocols

Software Administration

Software Development

Source Code/Configuration Management (SCM)

Static Analysis

Surveillance

Systems Administration/Management

Team Player

Technical Delivery

Technical Support

Test Plan/Schedule

Thought Leadership

United States Citizen

Vulnerability Scanners

Writing Skills

nginx Web Server

Workable

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Risk Adjustment Coder - Risk ManagementKettering Health

Nurse Practitioner (Per Diem)ComplexCare Solutions

Sr. Staff / Senior DevSecOps EngineerSciTec

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