AvMed, a division of Sentara Health Plans, is seeking a Risk Adjustment Clinical Nurse/Coder in Doral, Florida.
This full-time role performs compliance activities focused on risk adjustment in alignment with CMS and HHS requirements. The position includes prospective and retrospective medical record reviews, RADV audit support, provider coding review, vendor coding audits, provider engagement, and other ICD-10-CM risk adjustment activities.
The role also supports annual risk assessments, training, monitoring, auditing, control assessment, reporting, investigation, root cause analysis, and corrective action oversight. The specialist serves as a subject matter expert on risk adjustment diagnosis coding guidelines and helps coordinate risk adjustment gap elimination.
Education
- Associate degree in healthcare administration, nursing, health information management, accounting, finance, or another related field required
Certifications
- One of the following required:
- RN preferred
- CPC
- COC
- CIC
- CCS-P
- CCS
- RHIT
- RHIA
- Must obtain CRC certification within two years of employment
Experience
- 2 years of medical coding experience required
- In lieu of an associate degree, 4 years of medical coding experience required
- Thorough knowledge of ICD-10-CM Official Coding Guidelines and AHA Coding Clinics required
- 1 year of experience with paper and/or electronic medical records required
- Preferred: 1 year of risk adjustment program experience in a health plan or provider setting
- Preferred: experience with CMS, HHS, CDPS+RX, HCC models, and RADV reviews
Compensation and Perks
- Base pay range: $71,177.60 to $108,534.40 annually
- Additional compensation may include shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities
- Annual discretionary bonus may be available if eligibility criteria are met
Benefits Package
- Medical, dental, and vision coverage
- Life and disability insurance
- 401(k)/403(b) with employer match
- Paid time off, sick time, and holidays
- Paid parental and military leave
- Educational assistance or student loan repayment
- Adoption, fertility, and surrogacy reimbursement up to $10,000
- Emergency backup care
- Long-term, short-term disability, and critical illness plans
- Tuition assistance up to $5,250/year
- Student debt pay down up to $10,000
- Pet insurance
- Legal resources plan
Location
Florida, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$71,178 - $108,534
Remote work allowed
Yes
Posted
1 month ago