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CPC Required.

CRC Required or must be obtained within 6 months of hire.

HCC experience strongly preferred.

Local candidates preferred due to occasional onsite requirements.

Job Summary:

Evaluates and analyzes medical records for proper documentation and the correct  diagnosis (ICD-10-CM) codes for a wide variety of clinical cases and services for risk adjustment models (e.g., hierarchical condition categories (HCCs), Chronic Illness & Disability Payment System (CDPS), and U.S. Department of Health and Human Services (HHS) risk adjustment). CRCs review provider documentation and communicates coding opportunities for HCC coding so that disease processes are coded accurately to follow risk adjustment models.

Position Responsibilities:

Evaluates and analyzes medical records for proper documentation. Identifies and communicates coding deficiencies to clinicians in order to improve documentation for accurate risk adjustment coding.  Provides on-going training and education to the clinicians and physicians during 1:1, physician group, performance improvement and ad hoc meetings.

Manages and trends data collection for HCC and other risk coding.  Performs data mining from data captured through risk adjustment coding. Works with Manager and Director of VMG Quality Department to strategize and prioritize chart reviews and education. Assists with the development of action plans to improve documentation.

Completes chart reviews for various Values Based Programs focusing on annual review of suspect chronic conditions; utilizes payer portals as necessary to complete annual coding reviews.

Position Qualifications Required:

Required Experience:

Minimum of two years records coding experience or equivalent

Ability to perform functions in a Microsoft Windows environment

Ability to be detailed oriented and perform tasks at a high level of accuracy

Ability to make sound decisions

Demonstrate good communication and team work skills

Previous experience with an electronic legal health record system.

Understand the anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses

Understands medical coding guidelines and regulations including compliance and reimbursement and the impact of diagnosis coding on risk adjustment payment models

Required Education:

High School Diploma or GED required

Knowledge of Anatomy & Physiology/ Medical terminology required

Training / Certification / Licensure:

CPC required

Risk Adjustment Coder Certification (CRC) required or must obtain within six months of hire.

Hourly Rate: $26.22 - $40.65 The actual salary/rate will vary based on applicant’s experience as well as internal equity and alignment with market data.

Virtua offers a comprehensive package of benefits for full-time and part-time colleagues, including, but not limited to: medical/prescription, dental and vision insurance; health and dependent care flexible spending accounts; 403(b) (401(k) subject to collective bargaining agreement); paid time off, paid sick leave as provided under state and local paid sick leave laws, short-term disability and optional long-term disability, colleague and dependent life insurance and supplemental life and AD&D insurance; tuition assistance, and an employee assistance program that includes free counseling sessions. Eligibility for benefits is governed by the applicable plan documents and policies.

For more benefits information click here.