Job Description

Press space or enter keys to toggle section visibility Onsite or Remote Flexible Hybrid Work Schedule Posted Date 02/14/2025 Salary Range : $92,600 - $202,200 Annually Employment Type Duration Indefinite Job # 17874 Primary Duties and Responsibilities As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment, you will be an expert in risk adjustment coding and documentation, working closely with physicians, IPA coders, and risk adjustment teams associated with the health plan. Your responsibilities include: Conducting medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions. Analyzing coding patterns within medical groups. Providing customized education and updating educational materials for providers and medical groups. Participating in additional audit activities for CMS RADV as needed, including retrospective chart reviews. Traveling to provider offices within the Los Angeles area at least three days a week. UCLA Health salary range for this title code is $92,600 - $202,200 annually. Please note that the department's target pay range is $95,000 - $120,000 annually. Job Qualifications We are seeking a proactive, highly organized, detail-oriented individual with: A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required. Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area, required. Five or more years of experience with physician billing and/or coding, required. Three or more years of recent experience in CMS-HCC Risk Adjustment models V24 and V28, required. Three or more years of experience in providing education to clinical and non-clinical staff, required. Understanding of RADV and audit processes, required. Detailed knowledge and understanding of ICD-10, CPT and CPT (II), and HCPCS coding systems, required. Knowledge of Medicare Advantage STARS/HEDIS program and NCQA technical specifications, required. Six or more years of clinic or IPA and/or managed care experience, preferred. Knowledge of Medicare Advantage billing/claims submission and other related actions, preferred. Knowledge of HIPAA requirements, anatomy and physiology, required. Proficient in MS Word, Excel, PowerPoint, and Outlook, required. Ability to work effectively with common office software, coding software, and EMR systems, required. Registered Nurse (RN) or clinical qualifications a plus. Bachelor’s degree (healthcare or relevant field) or equivalent experience/training. #J-18808-Ljbffr Avature

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