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Seasonal Hcc Risk Adjustment Coding Jobs in Florida

Lee Health

Coder I - ProFee

Cape Coral, FL · Remote

$20 - $25.45/hr

Responsible for Diagnostic, HCC, Retrospective Coding, Documentation Quality Assurance, and ... Coding Specialist)RequiredorAdditional Requirements CRC (Certified Risk Adjustment Coder) required ...

Omega Healthcare Management Services

Coder HCC

Boca Raton, FL · On-site

$17.75 - $23.75/hr

The Coder HCC uses the most accurate codes for reimbursement purposes, research, epidemiology ... coding credential required. * Minimum of 2 years of recent, credentialed Risk Adjustment experience

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Seasonal Hcc Risk Adjustment Coding information

What is a seasonal HCC risk adjustment coder?

A Seasonal HCC Risk Adjustment Coder is a healthcare professional who reviews medical records to identify and code diagnoses that impact risk adjustment scores, typically during peak periods such as the Medicare Advantage sweep season. HCC stands for Hierarchical Condition Category, a coding system used by Medicare to predict healthcare costs based on patient diagnoses. These coders ensure accurate documentation, which directly affects insurance reimbursement and compliance. Seasonal roles are common due to the cyclical nature of risk adjustment reporting deadlines.

What are the key skills and qualifications needed to thrive as a seasonal HCC risk adjustment coder?

To thrive as a Seasonal HCC Risk Adjustment Coder, you need a strong understanding of ICD-10-CM coding, risk adjustment methodologies, and a certification such as CPC, CRC, or CCS. Proficiency in coding software, electronic health records (EHRs), and risk adjustment platforms is typically required. Attention to detail, analytical thinking, and strong organizational skills help ensure accuracy and compliance in reviewing medical records. These skills are essential to accurately capture patient risk profiles, support healthcare reimbursement, and maintain regulatory compliance.

What are the most common challenges faced by professionals in seasonal HCC risk adjustment coding roles, and how can they be managed?

Seasonal HCC Risk Adjustment Coders often face the challenge of managing high volumes of medical records within tight deadlines, especially during peak audit or submission periods. Ensuring coding accuracy and compliance with evolving CMS guidelines can also be demanding, as even minor errors may impact reimbursement and risk scores. Staying organized, regularly participating in training updates, and leveraging coding software tools can help manage workloads and maintain accuracy. Collaborating closely with clinical teams and other coders is vital for clarifying documentation and sharing best practices.

What is the difference between Seasonal Hcc Risk Adjustment Coding vs Hcc Risk Adjustment Coding?

AspectSeasonal Hcc Risk Adjustment CodingHcc Risk Adjustment Coding
CredentialsCertifications in coding and risk adjustmentCertifications in coding and risk adjustment
Work EnvironmentHealthcare facilities, insurance companies, remoteHealthcare facilities, insurance companies, remote
Industry UsageUsed seasonally for specific risk adjustmentsUsed year-round for ongoing risk management
Search IntentUnderstanding seasonal coding differencesGeneral risk adjustment coding practices

Seasonal Hcc Risk Adjustment Coding focuses on coding practices during specific times of the year, often related to seasonal health trends. In contrast, Hcc Risk Adjustment Coding involves continuous coding to manage patient risk profiles throughout the year. Both roles require similar certifications and work environments but differ mainly in their temporal focus and application.

What are the most commonly searched types of Hcc Risk Adjustment Coding jobs in Florida?

The most popular types of Hcc Risk Adjustment Coding jobs in Florida are:

What are popular job titles related to Seasonal Hcc Risk Adjustment Coding jobs in Florida?

For Seasonal Hcc Risk Adjustment Coding jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Seasonal Hcc Risk Adjustment Coding jobs in Florida look for?

The top searched job categories for Seasonal Hcc Risk Adjustment Coding jobs in Florida are:

What cities in Florida are hiring for Seasonal Hcc Risk Adjustment Coding jobs?

Cities in Florida with the most Seasonal Hcc Risk Adjustment Coding job openings:

Seasonal Hcc Risk Adjustment Coding jobs near you

Physician Advisor - Strategic Quality Performance

Lakeland Regional Health

Lakeland, FL • On-site

$161K - $215K/yr

Full-time

Re-posted 5 days ago

Lakeland Regional Health rating

7.2

Company rating: 7.2 out of 10

Based on 66 frontline employees who took The Breakroom Quiz

345th of 893 rated healthcare providers

Job description

Position Details
This is Full-Time Benefits Eligible position working 80 hours per biweekly pay period.
Location: 1324 Lakeland Hills Blvd Lakeland, FL - Onsite
Annual Salary: Min $161,200.00 Mid $215,300.80
*Please note this position is on-site in Lakeland, Florida with the possibility of becoming a hybrid role in the future.
Position Summary
The Physician Advisor serves as a liaison between the clinical document improvement (CDI) team, which includes hospital coders; members of the Hospital's administration; the Medical Staff of the hospital; and the hospital's Utilization Management to facilitate the development and implementation of clinical documentation improvement initiatives. The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation. The Physician Advisor is responsible for conducting clinical reviews referred by the Utilization Management, Coding and Clinical Documentation Improvement departments. The Physician Advisor will assist with reviews and appeals of DRG and medical necessity denials.
Position Responsibilities
Standard Work: Physician Advisor
  • Acts as a liaison between the CDI professionals, Health Information Management, and the hospital's medical staff to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity and risk of mortality, HCC/risk adjustment in addition to Diagnosis Related Group (DRG) assignment.
  • Perform concurrent and retrospective reviews of selected health records as it pertains to CDI and coding validation, and participate in the development of clinically appropriate and compliant provider queries to further clarify documentation.
  • Educates individual hospital staff physicians about International Classification of Diseases (ICD) coding guidelines and clinical terminology to improve their understanding of severity, acuity, risk of mortality, HCC/risk adjustment and DRG assignments on their individual patient records.
  • Assists with the evaluation and appeal of concurrent and retrospective denials and retrospective DRG downgrades. May perform peer-to-peer meetings as required.
  • Participates in the coding and CDI programs and identifies potential areas for improved documentation of services. Also participates in the Coding and CDI meetings and provides ongoing education to the team members.
  • Provides peer to peer communication to affect the appropriate response for those cases where the physician fails to respond or questions the need for queries.
  • Responsible for writing and submitting appeals (multiple levels as needed) specifically around medical necessity, non-covered services, authorizations, and inpatient/observation stay related denials. May perform peer-to-peer meetings as required.
  • The Physician Advisor is pivotal in leveraging his or her clinical position to demonstrate the association of care delivery with specificity in documentation through effective communication and education of the respective parties.
  • Provides his or her expert opinion in relation to clinical validity assessments, and, furthermore, the development of clinically robust and appropriate queries.
  • Serves as second level reviewer for UM, providing guidance on appropriate/alternate levels of care based on InterQual guidelines and other appropriate criteria.

Competencies & Skills
Essential:
  • Broad knowledge base of clinical medicine across all specialties.
  • Basic coding guidelines regarding the selection of the principal diagnosis and reporting additional diagnoses and procedures; understanding the DRG system; levels of comorbidities; and concepts of risk adjustment, severity of illness, risk of mortality, case mix index, prospective payment, hospital acquired conditions, patient safety indicators.
  • Organize tasks effectively and efficiently and the ability to act independently through the application of critical thinking skills.
  • Computer skills appropriate to position
  • Excellent written and verbal communication skills.

Qualifications & Experience
Essential: Medical Degree
Essential: Licensed to practice medicine in the State of Florida
Experience Essential:
- Minimum of two years of experience in conducting coding and CDI reviews.
- Knowledge of coding guidelines and how it translates from clinical documentation.
- Knowledge of DRGs, Risk of Mortality, Severity of Illness, Mortality Rate, HCC/risk adjustment, CMI and the impact of clinical documentation/coding in relation to these metrics.
- Excellent computer skills with prior exposure to use of Microsoft Office suite
People At The Heart Of All That We Do
  • Fosters an inclusive and engaged environment through teamwork and collaboration.
  • Ensures patients and families have the best possible experiences across the continuum of care.
  • Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.

Safety And Performance Improvement
  • Behaves in a mindful manner focused on self, patient, visitor, and team safety.
  • Demonstrates accountability and commitment to quality work.
  • Participates actively in process improvement and adoption of standard work.

Stewardship
  • Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
  • Knows and adheres to organizational and department policies and procedures.

Supervisor/Team Lead Capabilities
  • Demonstrates accountability for shift/team operations and care/service delivery to support achievement of organizational priorities.
  • Coaches front line team members to support ongoing professional development and hardwire technical and professional capabilities.
  • Creates a high performing team by building strong relationships, delegating work and nurturing commitment and engagement.
  • Manages team conflict/issues implementing appropriate corrective actions, improvement plans and regular performance evaluations.
  • Applies change management best practices and standard work to support departmental changes and ensure effective team transition.
  • Promotes a healthy and safe culture to advance system, team and service experience.

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