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Clinical Risk Adjustment Lead



United States
Posted on Thursday, May 2, 2024

Clinical Risk Adjustment Lead
Remote Opportunity

Reveleer is a healthcare data and analytics company that uses Artificial Intelligence to give health plans across all business lines greater control over their Quality Improvement, Risk Adjustment, and Member Management programs. With one transformative solution, the Reveleer platform enables plans to independently execute and manage every aspect of enrollment, provider outreach and data retrieval, coding, abstraction, reporting, and submissions. Leveraging proprietary technology, robust data sets, and subject matter expertise, Reveleer provides complete record retrieval and review services so health plans can confidently plan and execute risk, quality, and member management programs to deliver more value and improved outcomes.

What You’ll Do

  • Assisting Managers with clinical pends
  • Assisting with over-read feedback
  • Assigning manual assignments
  • Assisting with individual data entry production (MRR or OR1)
  • Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs)
  • Ensure collaboration among cross functional teams for the roll out of product releases
  • Additional duties as necessary to meet the obligations to our clients

About You

  • Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS, RHIT, RHIA etc.) through AAPC and/or AHIMA
  • Minimum of 5 years coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC)
  • Additional experience in facility (OPPS/IPPS) coding experience is preferred
  • Additional experience in Health Plan Risk Adjustment Data Validation Audit (RADV) experience is preferred
  • Excellent verbal and written communication skills, including the ability to effectively communicate with internal and external customers

Experience and Skills

  • Ability to work independently in a fast-paced remote environment with minimal supervision and guidance
  • Ability to interact with management and remote coding personnel
  • Possess strong organizational skills and attention to detail
  • Ability to adapt to changing priorities while managing a wide range of projects
  • Adaptive and flexible to new ideas and change
  • Advanced knowledge of medical terminology, anatomy and pharmacology
  • Advanced skills utilizing official coding resources for research and problem solving
  • Advanced skills and knowledge of computers, use of required software to perform job functions
  • Excellent written and communication skills and the ability to explain complex information

What You’ll Receive:

  • Competitive salary
  • Medical, dental, and vision benefits
  • 401k Matching
  • Generous PTO & holidays

Reveleer is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, gender identity, sexual orientation, age, marital status, veteran status, disability status or genetic information, in compliance with applicable federal, state and local law.