OTHER

FEED

UNKNOWN

Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines. Overview: Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient.

HOUR

Why Beebe?:
Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence. BenefitsIn addition to competitive compensation and wellness benefits (medical, dental, vision and prescription) Beebe Healthcare also offers:<ul><li>Sign-on and Referral Bonuses for select positions</li><li>Tuition Assistance up to $5,000</li><li>Paid Time Off</li><li>Long Term Sick accrual</li><li>Employer Contribution Plan</li><li>Free Short and Long-Term Disability for Full Time employees</li><li>Zero copay for drugs on prescription plan for certain conditions</li><li>College Bound 529 Savings Plan</li><li>Life Insurance</li><li>Beebe Perks via Work Advantage</li><li>Employee Assistance Program</li><li>Pet Insurance</li></ul>

Overview:
Provides thorough concurrent, prospective, and retrospective review of ambulatory medical record clinical documentation to ensure accurate and complete capture of the clinical picture, severity of illness, and complexity of the patient. Utilizes knowledge of official coding guidelines (ICD-10, CPT, HCPCs), Hierarchical Condition Categories (HCC), M.E.A.T (Monitored, Evaluated/Assessed/Addressed, Treated) standards, Risk Adjustment Factor (RAF) scoring, and AHIMA/ACDIS physician query brief. Provides education to providers on the importance of diagnosis specificity. May participate in developing, presenting, and disseminating provider communication and other activities related to clinical documentation.

Responsibilities:
<ul><li>Review provider documentation of diagnostic data from medical record to verify that all Medicare Advantage, MSSP and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum</li><li>Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)</li><li>Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines</li><li>Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation</li><li>Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing</li><li>Provides ongoing feedback to physicians and other providers regarding coding guidelines and requirements, including education and support for improvement in HCC coding and RAF scoring. Assists with educational in-services for physicians, other providers, and clinic staff relating to clinical documentation compliance related to billing.</li></ul>

Qualifications:
Required Certification/Licensure: Certified Risk Adjustment Coder (CRC) & Certified Coding Specialist (CCS-P), CCS, CPCMinimum of two years' experience in medical codingReliable transportation/Valid Driver's License/Must be able to travel at least 50% of work time

Credentials:
 

Education:
 

Entry:
USD $23.67/Hr.

Max:
USD $36.69/Hr.

Beebe Healthcare

RISK ADJUSTMENT CODING SPECIALIST - VBC OPERATIONS AND TRANSFORMATION

Certified Coding Specialist (CCS)

Claims Processing

Clinical Study Publications

Co-Payments

Compensation and Benefits

Content Management Systems (CMS)

Current Procedural Terminology (CPT)

Documentation

Driver's License

Employee Assistance Plan

Healthcare

Healthcare Common Procedure Coding System (HCPCS)

Healthcare Quality

ICD-10

Insurance

Life Insurance

Maintain Compliance

Medical Coding

Medical Diagnosis

Medical Records

Medicare

Prescription Drugs

Risk

Royal Air Force

Sales Prospecting

Support Documentation

Training/Teaching

Tuition Fees

Willing to Travel

[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: Sussex County, DE 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. 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>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

Centers for Medicare and Medicaid Services (CMS)

Clinical Nursing

Clinical Outcomes

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

Hospital

Medicaid

Medical Conditions

Medical Record System

Messaging Technology

Multilingual

Multitasking

National Committee for Quality Assurance (NCQA)

Nurse Practitioner

Nursing Credentials

Operations Processes

Patient Assessment

Primary Care

Regulations

Risk Management

Staff Requirements

Telehealth

Time Management

Treatment Plan

Coding jobs in Westlake, MD on your radar? Find the best of them right here on Monster.

The Best Coding Jobs in Westlake, MD | Monster

Coding Jobs in Westlake, MD

Jobs

Resume Resources

Get noticed by top employers!

Coding Jobs in Westlake, MD

Jobs

RISK ADJUSTMENT CODING SPECIALIST - VBC OPERATIONS AND TRANSFORMATIONBeebe Healthcare

Nurse Practitioner (Per Diem)ComplexCare Solutions

Resume Resources