Risk Adjustment Coder/Auditor

General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social and emotional needs.
The Risk Adjustment Coder/Auditor is responsible for reviewing our provider’s encounter’s in LWCC ensuring appropriate code capture of ICD-10, CPT Evaluation and Management and CPT II codes for HEDIS MEASURES are chosen. This position requires the Coder/Auditor to use their expertise and our Longevity Health Plan Official Coding Guidelines as reference in performing this task. Additionally, this position must use complex, critical thinking skills in their every-day work and have effective communication style with providers to affect change and ensure documentation and coding compliance.

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Key Tasks and Responsibilities:*

• Review and assign accurate ICD-10 medical codes for diagnoses performed by providers in LWCC.
• Review and assign accurate CPT Evaluation and Management codes for each encounter.
• Review and assign accurate CPT II codes to identify HEDIS measures with each encounter.
• Thoroughly comprehend our department’s Longevity Health Plan Official Coding Guidelines.
• Identify and communicate documentation deficiencies to providers by creating a provider query to improve documentation for accurate coding through LWCC.
• Understand the anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses in LWCC.

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Licensure:*

• Must be a Certified Coder by AAPC or AHIMA
• Auto liability insurance coverage per minimum required by home state.

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Education and Training:*

• High School Diploma

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Knowledge and Experience:*

• HCC Risk Adjustment Coding Experience
• Production Based Environment

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Company Overview:*
Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes. Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina.
In 2023, we expanded our service offerings to the broader health plan market. In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

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Company Disclaimers:*
Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations. While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve. If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination. To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site.

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

Submission of false information during the application process may result in immediate termination of employment without notice.

Job Type: Full-time

Pay: $66,000.00 - $81,000.00 per year