Richmond, VA · On-site
$41.85/hr
... RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
Richmond, VA · On-site
$41.85/hr
... RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.
CC00496 VIMS1 | RADV | CCRM Job Family: Staff - Lab & Research Support Worker Sub Type: Wage ... Ability to write, test, and troubleshoot code independently. * Strong analytical and problem ...
CC00496 VIMS1 | RADV | CCRM Job Family: Staff - Lab & Research Support Worker Sub Type: Wage ... Ability to write, test, and troubleshoot code independently. * Strong analytical and problem ...
| Aspect | Radv Coding | Medical Billing Specialist |
|---|---|---|
| Credentials | Certification (e.g., AAPC, AHIMA), coding credentials | Billing and coding certifications, but often less specialized |
| Work Environment | Hospitals, clinics, outpatient facilities | Medical offices, billing companies, healthcare providers |
| Industry Usage | Used for accurate coding for reimbursement and records | Handles billing, claims submission, and payment processing |
| Search & Comparison Intent | Focuses on coding accuracy and compliance | Focuses on billing processes and claims management |
Radv Coding primarily involves assigning accurate medical codes for radiology procedures, ensuring compliance and reimbursement. Medical Billing Specialists handle the billing process, submitting claims and managing payments. While both roles work closely within healthcare revenue cycle management, Radv Coders focus on coding accuracy, whereas Billing Specialists focus on financial transactions.
$41.85/hr
Other
Posted 3 days ago
7.8
Based on 28 frontline employees who took The Breakroom Quiz
Company :
Highmark Inc.
Job Description :
JOB SUMMARY
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. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding. Supports all Remote Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses and HCC disease categories. Supports other key objectives to drive capture of correct Risk Adjustment coding including documentation improvement, provider education, analyzing reports, and identifying process improvements.
ESSENTIAL RESPONSIBILITIES
Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD). 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. Adheres to CMS Guidelines for Coding and Highmark's Policy and Procedures to guide HCC coding decision making. Maintains RPM coding accuracy and productivity requirements.
Assists with Regulatory Audits by performing first coding review and ranking of charts. Build partnerships and work within coding teams and internal partners critical to HCC coding.
Participates on ad-hoc projects per the direction of Leadership to address the needs of the department. Provides recommendations for process improvements and efficiencies.
Engages in RPM Coding educational meetings and annual coding Summit.
Other duties as assigned.
EDUCATION
Required
Substitutions
Preferred
EXPERIENCE
Required
Preferred
LICENSES or CERTIFICATIONS
Required (any of the following)
Certified Professional Coder (CPC)
Certified Risk Coder (CRC)
Certified Coding Specialist (CCS)
Registered Health Information Technician (RHIT)
Preferred
SKILLS
Critical Thinking
Attention to Detail
Written and Oral Presentation Skills
Written Communications
Communication Skills
HCC Coding
MS Word, Excel, Outlook, PowerPoint
Microsoft Office Suite Proficient/ - MS365 & Teams
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Remote Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Occasionally
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
No
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$27.02
Pay Range Maximum:
$41.85
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J283469
Get the full story on Breakroom
Sourced by ZipRecruiter
A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2022 consolidated revenues totaling $26 billion. And we're proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.
Health care and social assistance and insurance services
10,000+ Employees
Pittsburgh, PA, US
