LM Hjobs
Risk Adjustment Quality Specialist
Lawrence, KS
Sponsorship not specifiedDetected 20 days ago
ICD-10Patient CareProblem SolvingClaims Management
About the role
- The Risk Adjustment Quality Specialist plays a vital role in coordinating and supporting prospective, concurrent, and retrospective reviews to assist with patient care management.
- The position provides education and facilitates chart retrieval for Health Plan audits and reports.
- Monitor revenue opportunities related to value-based care.
Responsibilities
- Manage the provider query process to clarify documentation and ensure the completeness and accuracy of patient diagnoses, particularly related to chronic conditions.
Requirements
- Strong knowledge of CMS risk adjustment and quality initiatives, including Hierarchical Condition Categories (HCCs).
Benefits
- When your cup is full - with joy, purpose and lifelong health - it shows.
- At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career.
- From flexible, work-life harmony to competitive pay and great advancement potential, find everything you're looking for at LMH Health.
- Tuition reimbursement to support continuing education
- Excellent benefits
- Perform comprehensive reviews of patient medical records for documentation consistency and adequacy to identify all appropriate coding based on Centers for Medicare & Medicaid Services (CMS) HCC categories.
- Utilize evidence based practices to provide providers with targeted feedback and education on improving documentation and coding accuracy, specifically related to HCC.
- Collaborate with medical staff to clarify documentation and support accurate coding and reimbursement.
- Maintain compliance with policies, procedures, and continuing education requirements.
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