that impact severity of illness (SOI) and risk of mortality (ROM) 2+ years of ICD-10-PCS coding including but not limited... and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth...
About the role This role is on our Worldrisk line of business and assists the underwriters by screening risk... first point of call for all UAs in the region Review new submissions against prescribed criteria to determine if risk...
, coding standards, and regulatory requirements. The Manager oversees operational QA testing, examiner-level audit programs... across the entire operational claims lifecycle including claim intake, data entry, adjudication, pricing, coding accuracy...
), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified Coding Specialist... to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas...
Risk Adjustment Business Analyst who can bridge regulatory requirements with operational execution across Medicare... risk adjustment models (e.g., Medicare Advantage) may also be preferred or beneficial. CRC certified...
Experience: Seven years of experience with coding, risk adjustment models (Medicare Advantage) and leadership. Essential... Credentials: CRC (Certified Risk Adjustment Coder), CPMA (Certified Professional Medical Auditor), CDEO (Certified...
with others regarding clinical documentation improvement (CDI) and risk adjustment (mortality) findings. Maintains knowledge of Centers... of the interdisciplinary care team member, an auditor, and an educator ensuring medical records are complete and clinical...