RISK ADJUSTMENT CLINICAL REVIEWER

RISK ADJUSTMENT CLINICAL REVIEWER

  Not Disclosed

  Richardson, TX (100% Remote)

  2.0 Months

  Not Disclosed

  Not Disclosed

  Healthcare

  $40/hour - $45/hour

Job Description

Basic Function:

Function as a clinical reviewer for HHS risk adjustment.

Responsibilities:

Function as a clinical reviewer for HHS risk adjustment project reviewing medical record documentation for the presence of validating information that support claims data submitted by providers. Prepare medical records by applying structered auditing criteria, following defined procedures for saving approved medical records, and moving records through check points as defined by approved systematic process. Discern when dates gaps exist for missing record, and assist with and/or provide information to chaser(s) for follow up request of additional records. Some claims investigations/research. The candidate will work in a database environment and multiple PC apps simultaneously. The individual must have good communications skills, and knowledge of medical office environment. The candidate must possess the ability to adapt to change.

Requirements:

Registered Nurse (RN) with current unrestricted clinical license to practice in state of Texas.
2 years clinical practice experience
1 year experience in clinical auditing or medical review preferred
Knowledge of clinical data auditing or HHS risk adjustment is helpful
Perform review on clinical data and abstract documentation to support identified Dx codes
Work collaboratively with providers to gather and transfer data.
Familiarity with claims investigation or research helpful
Awareness of claims processes and claims processing systems
Organizational skills and prioritization skills
Clear and concise verbal communication skills
Analytical skills
Attention to detail is a plus
Ability to deal with internal and external customers, including Representatives and Providers
PC proficiency to include Microsoft Word and Excel and health insurance databases
Work Experience: Experience performing chart audits and review preferred. Coding experience is a plus. Experience using or viewing electronic medical records

PREFERRED JOB REQUIREMENTS:


BSN, BS/BA, or Bachelor Degree.

Note :

Remote
VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.