Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment

DescriptionAs 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. You will:

Conduct medical record audits for physicians (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes related to chronic conditions

Analyze coding patterns within medical groups.

Provide customized education and updating educational materials for providers and medical groups.

Participate in additional audit activities for CMS RADV as needed, including retrospective chart reviews.

Travel to provider offices within 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.Note: This posted position is 1 of 2 positions available for hire. All applicants will apply through this requisition and if selected will be hired into one of the available positions.QualificationsWe are seeking a proactive, highly organized, detail-oriented individual with:

A Certified Professional Coder (CPC) certification or Certified Coding Specialist (CCS) certification, required

A Certified Risk Adjustment Coder (CRC), required

Registered Nurse (RN) or clinical qualifications a plus

Bachelor's degree (healthcare or relevant field) or equivalent experience/training

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

Six or more years of clinic or IPA and/or managed care experience, preferred

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

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

Reliable transportation to conduct ongoing face-to-face interactions with providers in the Los Angeles area, required

Note: Skills may be subject to test.UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.