Risk Adjustment Coding Specialist supporting risk adjustment efforts through chart reviews and provider education. Estimated travel up to 75% in Inland Empire region, specifically LA or Orange County.
About the role
- Clinical and Coding Specialist for South Carolina residents handling healthcare coding and overseeing medical reviews. Requires a BSN or ADN with substantial healthcare and coding experience.
Responsibilities
- State Government Project Need South Carolina Consultants Only - No relocation is allowed
- Respond with your updated resume and contact details to the specified email.
- Collaborate with internal teams to analyze projects and provide expert coding support.
Requirements
- Bachelor of Science in Nursing (BSN) or Associate Degree in Nursing (ADN)
- Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse.
- Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist).
- ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment
- 5+ years in healthcare insurance; medical review, program integrity, or appeals
- 5+ years working with IT developers/programmers in a payor environment.
- 5+ years Medical Coding in payer environment
- 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.)
- 5+ years knowledge of ICD/CPT/HCPCS translation and coding methodologies.
- 5+ years’ knowledge of anatomy, physiology, pharmacology, and medical terminology.
- Preferred Qualifications: 5+ years’ experience in policy remediation.
- 5+ years claims processing systems experience.
- 5+ years knowledge of Microsoft Office
- 5+ years Optum Encoder and/or other medical coding software programs.
Benefits
- Flexible work from home options
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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