Medicare Risk Adjustment Coder

Role Overview

• Monitor and collect Medicare Stars data to improve health plan ratings
• Conduct specific medical record reviews
• Analyze findings and make recommendations for corrective actions
• Prepare formal documentation for compliance with applicable standards
• Perform Health Plan Employer Data Information Set data collection (HEDIS) and National Committee for Quality Assurance (NCQA) accreditation activities

Requirements

• Bachelor's in a job-related field
• 4 years job related work experience or Associate's and 2 years job related work experience
• Professional certification in nursing, pharmacy, medical assistant, or other healthcare training
• Certified professional in Healthcare Quality (CPHQ) or other relevant certifications
• Minimum 2 years of managed care, quality improvement, medical research or clinical experience
• Minimum 2 years working with HEDIS standards and Medicare Advantage
• Must be familiar with clinical terminology and medical records

Benefits

• Subsidized health plans
• Dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more