AvMed, a division of Sentara Health Plans in the Florida market, is hiring a Risk Adjustment Nurse/Coder (RN/CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA) in Doral, FL! This is a full-time permanent position (40 hours) with standard working hours from 8am to 4:30pm EST, Monday to Friday. The position is hybrid, requiring 2 days onsite at AvMed Doral Office, 3470 NW 82nd Ave Suite 1100, Doral, FL 33122, and 3 days remote. The Risk Adjustment Clinical Coder/Nurse performs compliance activities focused on risk adjustment in accordance with CMS and HHS. Responsibilities include prospective/retrospective medical record reviews, CMS/HHS Risk Adjustment Data Validation audits, reviewing provider coding for professional and inpatient/outpatient services, supporting risk adjustment data validation, medical record retrieval, vendor coding audits, provider engagement, and all risk adjustment ICD-10-CM coding-related activities. The role also involves conducting annual risk assessments, training, monitoring, auditing, control assessment, reporting, investigation, root cause analysis, corrective action oversight, vendor quality oversight audits, final coding determination for non-agreeable coding, and serving as a subject matter expert on risk adjustment diagnosis coding guidelines. Coordination of risk adjustment gap elimination with clinical and quality gap elimination is required, along with maintaining fluency in workings and financial implications of applicable risk adjustment models. Education required is an associate degree in healthcare administration, nursing, health information management, accounting, finance, or related field. Certifications required include one of the following: CPC, COC, CIC, CCS-P, CCS, RHIT, or RHIA, with a requirement to obtain Certified Risk Adjustment Coder (CRC) certification within two years of employment. Experience required is 2 years of medical coding or 4 years if no associate degree, thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics, and one year experience with paper and/or electronic medical records. Preferred experience includes one year with risk adjustment programs in a Health Plan or Provider setting, familiarity with CMS, HHS, and/or CDPS+RX HCC models, and CMS and/or HHS RADV experience. AvMed is a not-for-profit health plan with over 50 years of experience, part of Sentara Healthcare, a large integrated healthcare delivery system. The company offers a family-friendly culture, community involvement, and opportunities for development and growth. Benefits include medical, dental, vision plans, adoption/fertility/surrogacy reimbursement, paid time off, parental leave, emergency backup care, disability and critical illness plans, life insurance, 401k/403B with employer match, tuition assistance, student debt pay down, certification reimbursement, pet insurance, legal resources, and potential annual discretionary bonus. Sentara Health is an equal opportunity employer committed to diversity and inclusion and maintains a tobacco-free environment.
By applying, you consent to your information being transmitted by Jooble to the Employer, as data controller, through the Employer’s data processor SonicJobs.
See Sonicjobs Privacy Policy at and Terms & Conditions at and SonicJobs Privacy Policy at and Terms of Use at
...Chantilly, VA Work Type: Onsite Remote Work: No Job Description Gridiron... ...media training materials; providing transcription services; providing event and exhibit strategies... ...benefits package including medical, dental, vision insurance, HSA, FSA, 401...
...Summary: Better Hospitality Group is seeking an Events & Social Media Manager to support our dynamic and fast-growing team. As the... ...prepared for upcoming events ~ No prior event coordination experience required Compensation and Benefits: ~$85,000 Base...
...as an Infrastructure Weapons Systems Structures Section Lead Engineer, and be part of a diverse and enthusiastic team that solves some... ...level and/or job specifics.**Infrastructure Mechanical/Aerospace Engineer****112887BR**EEO Career Site Equal Opportunity Employer...
...Job Description Talent Acquisition Partner - Come Build Your Career with Vibra Travels!&##127757; Remote Opportunity Local to PA Preferred &##129658; Healthcare Agency Experience Required At Vibra Travels , we move fast, stay focused, and put people...
**Description**Network EngineerPurpose and Scope/General Summary: We are looking for a Network Engineer for JBS IT that will reporting onsite to a poultry plant in the southeast.JBS USA is seeking a Network Engineer who can design, implement and manage standards-based...