Lead Hierarchical Condition Category (HCC) Coding Specialist (Remote) Highmark IncLead Hierarchical Condition Category (HCC) Coding Specialist (Remote)PARemoteApplies extensive clinical and coding knowledge and abilities, independently conducts coding research, aligns all aspects of audit, including coding adjudication and rebuttals with audit vendor, obtains provider attestations, identifies & obtains missing medical records, compares audit results to claims, and thoroughly reviews all in-house charts in chart repository for validation of audit. Completes analytics on providers and/or provider group coding trends and creates and delivers externally facing presentations to provider documentation and accuracy, act as the point person for the provider office for any questions and additional trainings, as needed.
NewHierarchical Condition Category (HCC) Coding Specialist Highmark IncHierarchical Condition Category (HCC) Coding SpecialistPAp>This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals.
Physician Coding Auditor Ensemble Health PartnersPhysician Coding AuditorPARemote$57,400–$99,000 / yearp>The Physician Coding Auditor develops and implements strategic needs analyses and training plans for coding leadership; coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW. Educating - Assesses the educational needs of coding staff and providers that are contracted/employed and outlined in the client SOW (included Provider Education verbiage) and develops programs or researches educational resources to meet those needs.
DRG Specialist University of Pittsburgh Medical CenterDRG SpecialistPittsburgh, PAp>Licensure, Certifications, and Clearances: Certified Coding Specialist (CCS OR Certified Professional Coder (CPC OR Certified Registered Nurse Practitioner OR Doctor of Medicine (MD OR Registered Health Information Administrator OR Registered Health Information Technician (RHIT OR Registered Nurse (RN) Act 34*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC agreement, a multistate license issued by a participating NLC state. Preferred Experience: 3 years' experience in an inpatient coding role, or clinical acute care medical/surgical experience to include critical care in conjunction with expanded knowledge of coding and DRG assignment.
Supervisor Strategic Risk Adjustment and Quality Highmark IncSupervisor Strategic Risk Adjustment and QualityPAOversee the teams' processes to conduct multiple type of audits, government and internal, identify gaps, repeating issues and communicate results in provider office sites with data analysis from office site and/or medical record reviews to (a) continually improve the care, service to members and patient satisfaction; (b) coordination with other Highmark programs for credentialing, quality improvement programs, value based programs, care management programs, to achieve high caliber results, and (c) ensure medical records meet regulatory requirements. Contribute to the department's strategic planning efforts by identifying tactical opportunities for improvement, recommending solutions, and developing materials especially directed at Risk Adjustment, Quality/HEDIS, and Medical Record Documentation projects related to the development and implementation of educational opportunities.
Physician Educator HPL- Remote- Clearfield County, PA & Surrounding Area! University of Pittsburgh Medical CenterPhysician Educator HPL- Remote- Clearfield County, PA & Surrounding Area!Pittsburgh, PARemoteThe Physician Educator is responsible for implementation of strategic plans and coordination of all aspects of provider and practice education, including but not limited to scheduling, tracking, follow-up, workflow integration, medical record documentation, coding, and electronic health records. Analyze medical record documentation and coding through a chart review process that identifies incorrect coding, coding lacking supporting documentation, and missed opportunities to capture risk adjustment diagnoses and associated revenue.