Remote Commercial Insurance Jobs in Ocala, FL (NOW HIRING)

Description
Welcome to Pathways Health Partners, the Accountable Care Organization (ACO) that's leading the charge in helping independent providers transition to Value-Based Care.
What We Do:
Medicare REACH ACO: We're at the forefront of Medicare innovation.
Medicare Advantage MSO: Providing top-notch services to our Medicare Advantage patients.
Commercial MSO: Managing care for approximately 16,000 patients across North-West/Central Florida.
Where We Operate: From The Villages to St. Petersburg, and across to Mount Dora, we've got you covered!
Our Services:
Hospital Medicine Group: Delivering exceptional care in hospitals.
Affiliated Medical Practices: Managing several top-tier medical practices.
Insurance Agency: Offering comprehensive insurance solutions.
Join us on our journey to better health and value-based care!
Job Summary
The HCC Risk Coder plays a vital role in coordinating and supporting retrospective and concurrent chart reviews while providing education and facilitating chart retrieval for Health Plan audits and reports. This position requires a comprehensive understanding of Hierarchical Condition Categories (HCC) coding to accurately translate, input, extract, and validate medical record data.
Position Responsibilities:
• Review and assess documentation to accurately translate chronic conditions into the appropriate diagnosis codes from outpatient medical records.
• Extract data for Health Plan reports and input data collected from HCC programs.
• Assist in obtaining medical records from Providers to support audits requested by Health Plans.
• Help coordinate training sessions for Physicians and staff on relevant coding guidelines and compliance standards.
• Review provider documentation to verify that HCC codes are accurate and meet required documentation guidelines.
• Assign appropriate ICD-10-CM codes that map to risk adjustment models and identify documentation discrepancies, querying providers for clarity when necessary.
• Participate in clinical documentation improvement initiatives and maintain regular attendance at team meetings.
• Handle special projects as assigned and perform other duties as needed.
Qualifications and Education Requirements

1. High School Diploma or GED. An active CRC (certified risk adjustment coder) or CPC (certified professional coder) preferred.

2. Understanding of regulations regarding medical coding and documentation; Administrative responsibilities, professional written and verbal communication, typing skills.
3. Documented training in Medicare Risk Adjustment (MRA), HCC coding documentation guidelines, rules, and regulation.
4. Two years' demonstrated experience in a medical or health plan environment
5. Excellent computer skills with experience in Outlook, MS Office, MS Excel, MS Word
Pathways Health Partners is a growing company based in Leesburg, FL. We are proud of our professional yet family culture with the executive team working daily alongside our team members. We provide competitive salaries and a benefits package that is second to none.

• Medical Insurance for Employee and Spouse/Significant Other paid up to 100% by Pathways!
• Addition of family coverage for dependents at a fraction of the cost
• 25K life insurance for employees 100% paid by Pathways!
• Increasing Employee coverage or adding spouse/dependents at a fraction of the cost
• Vision and Dental Coverage available at a very low cost for employees, spouses, and family
• 401K retirement plan with 100% match up to 4% of annual pay
• Paid holidays
• Ample Paid Time Off (PTO) for vacation/sick/personal days

We look forward to speaking with you about this opportunity!