Coding Team Lead, HCC Risk Adjustment Coding
Datavant
Data Quality Auditor, Coding
CVS Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Florida, Idaho, Vermont • 🇺🇸 United States
Visit company websiteSalary
💰 $19 - $42 per hour
Job Level
Junior
About the role
- Perform audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes to CMS for risk adjustment processes
- Support coding judgment and decisions using industry standard evidence and tools
- Abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in office and/or facility settings
- Ensure coding guidelines and regulations compliance and establish medical necessity
- Identify clinically active vs. historical conditions
- Ensure diagnosis codes are appropriate, accurate, and supported by clinical documentation per State and Federal regulations and internal policies and procedures
- Utilize medical records to ensure support is documented for etiology and manifestations of disease processes
- Adhere to stringent timelines consistent with project deadlines and directives
- Conduct self-process audits to ensure compliance with internal policies and regulatory guidance from CMS, OIG or other Regulatory body
Requirements
- Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
- CPC (Certified Professional Coder) required or CCS-P (Certified Coding Specialist-Physician) required
- CRC (Certified Risk Adjustment Coder) (mentioned but not required?)
- Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
- Experience with International Classification of Disease (ICD) codes required
- Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred
- Education AA/AS or equivalent experience
- Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 3 years for CPC
- Anticipated Weekly Hours 40
Benefits
- Affordable medical plan options
- a 401(k) plan (including matching company contributions)
- an employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
- Paid time off
- flexible work schedules
- family leave
- dependent care resources
- colleague assistance programs
- tuition assistance
- retiree medical access
- CVS Health bonus, commission or short-term incentive program eligibility
ATS Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
ICD codingmedical record documentation reviewdiagnosis codingauditingcoding guidelines compliancemedical necessity determinationclinical documentation reviewrisk adjustment processesHCC (Hierarchical Condition Categories)self-process audits
Soft skills
attention to detailtime managementanalytical skillsdecision makingcommunication skills
Certifications
CPC (Certified Professional Coder)CCS-P (Certified Coding Specialist-Physician)CRC (Certified Risk Adjustment Coder)
