Revenue Integrity RN Auditor
Tampa Family Health Centers
99 reviews
Tampa, FL 33612
Part-time
Tampa Family Health Centers
99 reviews
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Job details
Job Type
Part-time
Full Job Description
Pay, Benefits, Weekday Schedules, Paid Time Off, and Holidays! Sound like a great place to work? It is!
Come and enhance your career in an environment that provides the opportunity to make a real difference in the local community. With our 16 convenient locations, Tampa Family Health Centers, a Federal Qualify Health Center, is proud to provide high quality, accessible medical care to the diverse community of Tampa. With Family Practice, Internal Medicine, Pediatrics, Gynecology/Obstetrics, Family Planning, Behavioral Health, Podiatry, Dental (Pediatric & Adult) and Pharmacy practices, we take care of Tampa’s families.
Responsibilities and Core Functions:
The Chronic Disease Medical Reviewer (CDMR) acts as a Chronic Disease Medical Risk Assessor for several insurance plans for Tampa Family Health Centers (TFHC). CDMR works to increase Risk Adjustments Factors in conjunction with Hierarchical Conditions Category.
Specific Authorities and Duties:
• Support the Director of Managed Care and Population Health, assist with projects, improve ENS process
• Identify clinically important information from patient’s medical records and integrate findings with respective insurance chronic disease.
• Review patient records to identify discrepancies, inconsistencies, or missing data that pertains to respective insurance chronic disease.
• Apply clinical background to review medical conditions and alert providers about possible chronic disease entities based on respective insurances’ claims-based chronic disease.
• Outreach to patients with multiple chronic diseases to ensure health coordination.
• Uses payor portals (Availity/Practice Assist/Stellar) to complete chart reviews and submit supplemental data like MCAIP for incentive programs
• Support contracted/part time provider under the Director for specialty cases, telehealth incentives, and chart reviews
Knowledge and Experience:
• Strong interpersonal, verbal and written communication skills
• Excellent customer service skills
• Experience with HCC and CPT coding,
• Experience using payor portals (Availity/Practice Assist)
• Proficient with using electronic health records.
• Experience using office programs (excel and word)
Education, Certification, Training and License:
• RN
• HEDIS, ENS, Incentive Program
• Bilingual (English and Spanish) preferred.
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