Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor

Company: Georgia Orthopaedic Society.
Location: Los Angeles
Posted on: November 6, 2024

Job Description:

DescriptionAs the Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, 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 the Los Angeles area at least three days a week.UCLA Health salary range for this title code is $92,600-202,200/annually. Please note that the department's target pay range is $95,000 - $120,000/annually.Note: This posted position is 1 of 4 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.QualificationsWe are seeking a proactive, highly organized, detail-oriented individual with:
  • A Certified Professional Coder (CPC) certification and a Certified Risk Adjustment Coder (CRC), required.
  • Bachelor's degree (healthcare or relevant field) or equivalent experience/training.
  • Five or more years of experience with physician billing and/or coding, required.
  • Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28, required.
  • Three or more years of experience in providing education to clinical and non-clinical staff, required.
  • Six or more years of clinic or IPA and/or managed care experience, preferred.
  • Understanding of RADV and audit processes, required.
  • Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems required.
  • Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required.
  • Knowledge of Medicare Advantage billing/claims submission and other related actions, preferred.
  • Knowledge of HIPAA requirements, anatomy and physiology, required.
  • Proficient in MS Word, Excel, PowerPoint and Outlook, required.
  • Ability to work effectively with common office software, coding software, and EMR systems, required.
  • Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area, required.Note: Skills may be subject to test.
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Keywords: Georgia Orthopaedic Society., Fullerton , Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor, Human Resources , Los Angeles, California