Job Description

Clinical Operations Specialist
Remote

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.

This is a Full-Time (FT, 40 Hours a week) remote position to perform duties for Risk Adjustment Coding and related Audit initiatives. As a Clinical Operations Specialist, you will be responsible for, supervisory duties and management support of a team of part-time remote coders. enabling their review of medical records. The Coders facilitate chart assignment, assist with client calls (if necessary), drive Risk and IVA program and project readiness. The main goal of this position is to ensure timely, accurate, and quality review of medical records by Coders.

Hourly Rate: $31.25/hour

Essential Duties and Responsibilities:

• Review of medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog, larger chart page counts
• Work population of clinical pends, with goal to clear within 72 hours
• Updating and maintaining training course material for medical record abstraction and data entry (HEDIS, RISK, IVA)
• Reviewing training test scores and sending feedback if necessary
• Assigning and overreading disciplinary charts- (this is a chart move back) all projects
• Reviewing reports daily for QA scores during the season(s) (abstractors, coders, HPs)
• Maintaining an accuracy score of 95% on all work submitted (all projects)
• Ability to adapt to changing priorities in managing a wide range of projects.
• Must be able to work independently and in a team environment
• Remote mentoring/ coaching (for all projects) in a group or 1:1 session with staff and leadership
• Client trainings (Reveleer technology, if needed)
• Over read challenges for all projects (reviewing abstractor/coder OR1 feedback challenges)
• Oversite and coordination of IVA documentation audits: ENR/RXC/ATT/DOB/GEN-
• Assist in training and successful adoption of Natural Language Processing/” Bot” -assisted coding reviews and relating tools/reporting
• Reviewing reports for workload assignments, looking at inventory by project to make sure sufficient headcount are assigned per workload (all projects) multi time zone coverage/ shift coverage- evening/ weekends/holidays
• Managing and addressing questions and clarifications that coders submit to a designated online communication forum and “Q&A” email mailbox while reviewing charts
• Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
• Stay up to date with Risk/IVA protocols (coding clinics, coding guidelines)
• Maintain ongoing communication with Clinical Management team regarding coding workload, turnaround time expectations and deliverables
• Additional duties as necessary to meet the obligations to our clients

Qualification Requirements:

• Current Coding Certification (CPC, CPC-P, CPC-H, CPC-I, CRC, CCS) 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

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

Hourly Rate: $31.25 / hour

Our compensation reflects the cost of labor across several US geographic markets. Pay is based on several factors including market location and may vary depending on job-related knowledge, skills, and experience.

Reveleer E-Verifies all new hires.

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.

Job Tags

Remote job, Hourly pay, Holiday work, Full time, Part time, Local area, Flexible hours, Shift work, Weekend work, Afternoon shift,

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