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Job Description: HEDIS Abstractor (RHIA / Coder) HEDIS Abstractor (RHIA / Coder) Location: Iselin, NJ Salary:  Experience: 1. year(s) Job Type: Temporary / Consulting Job ID: U1014179       About the Opportunity A healthcare company in New Jersey is looking to fill an immediate need with the addition of a new HEDIS Abstractor (RHIA / Coder) to their growing staff. In this role, the HEDIS Abstractor (RHIA / Coder) will be responsible for determining appropriate codes for medical services and procedures to ensure accurate adjudication of claims as well as working with the HEDIS team to collect member records and conduct reviews of these records by contacting providers and placing the results collected into a specific data base. Apply today! Company Description Healthcare Company Job Description The HEDIS Abstractor (RHIA / Coder) will be responsible for: Reviewing operative notes and various forms and medical records to identify proper coding of claims Providing training and guidance to service operations staff to ensure accurate claims adjudication and explanation of benefits Reviewing denied claims and advises service staff regarding appeals Maintaining current knowledge of coding and keeps current with medical compliance and reimbursement policies impacting claims payment Required Skills 1+ year of related work experience High School Diploma / GED Certified Professional Coder (CPC) with designation from an accredited source such as American Health Information Management Association, American Academy of Professional Coders, or Practice Management Institute Understanding of codes for services based on diagnosis and procedure Working knowledge of Medical Records Microsoft Office/Suite proficient (Excel, Outlook, Word, etc.) Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Associate's and/or Bachelor's Degree in a related field Prior HEDIS experience RHIA certification

Job Description: Quality Practice Advisor Quality Practice Advisor Location: Trenton, NJ Salary:  Experience: 3. year(s) Job Type: Temporary / Consulting Job ID: U1011207       About the Opportunity A healthcare company in New Jersey is actively seeking a licensed / certified professional to join their growing staff as a Quality Practice Advisor. In this role, the Quality Practice Advisor will be responsible for educating providers and supports provider practice sites in regards to the National Committee for Quality Assurance (NCQA) HEDIS measures. Apply today! Company Description Healthcare Company Job Description The Quality Practice Advisor will be responsible for: Advising and educating large Provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with NCQA requirements Collecting, summarizing and trending provider performance data to identify and strategize opportunities for provider improvement Delivering provider specific metrics and coach providers on gap closing opportunities Identifying specific practice needs where the company can provide support Developing, enhancing and maintaining provider clinical relationship across product lines Leading and/or supporting collaborative business partnerships, elicit client understanding and insight to advise and make recommendations Partnering with Physicians / Physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education Providing resources and educational opportunities to provider and staff Documenting action plans and details of visits and outcomes and reporting critical incidents and information regarding quality of care issues Communicating with external data sources as needed to gather data necessary to measure identified outcomes Required Skills 3+ years of directly-related experience in HEDIS record collection with analytical review / evaluation and/or Quality Improvement; 1+ year of Managed Care experience Bachelor's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following licenses: Certified Coding Specialist (CCS); Licensed Practical Nurse (LPN); Licensed Clinical Social Worker (LCSW); Licensed Mental Health Counselor (LMHC); Licensed Master Social Work (LMSW); Licensed Marital and Family Therapist (LMFT); Licensed Vocational Nurse (LVN); Licensed Registered Nurse (RN); and/or, Acute Care Nurse Practitioner (APRN) (ACNP-BC) Solid analytical skills Computer savvy Great interpersonal skills Excellent communication skills (written and verbal) Strong attention to detail Highly organized Desired Skills Master's Degree in Healthcare, Public Health, Nursing, Psychology, Health Administration, Social Work or related field One of the following licenses: Health Care Quality and Management (HCQM); Certified Healthcare Professional (CHP); and, Certified Professional in Healthcare Quality (CPHQ)

Job Description: Capital Health is the region's leader in advanced medicine with significant investments in advanced technologies and the area's most experienced physicians. Comprising its two hospitals (Capital Health Regional Medical Center in Trenton and Capital Health Medical Center - Hopewell), an outpatient facility in Hamilton Township, and various primary and specialty care practices across the region, Capital Health is a growing healthcare organization that is accredited by The Joint Commission and received Magnet® status three times in recognition of its quality patient care, innovations in professional nursing practice, and nursing excellence. Responsibilities: Provides expertise in development and maintenance of rules, policies and procedures to ensure organizational compliance with industry standard coding rules and guidelines. Verifies accurate assignment of diagnoses and procedures within the medical record to comply with federal and state regulations. Acts as the primary department expert on APCs and DRGs while consistently monitoring regulatory updates and their implementation, including OCE, NCD and LCD edits. Conducts regular audits and reviews of medical records at a senior level, and assists with external and internal reviews for coding accuracy. Reviews claim denials and rejections pertaining to coding and medical necessity issues, and exercises discretion and judgment when recommending corrective action plans, such as educational programs, to prevent similar denials and rejections from occurring in the future. Assists in implementation of policy and procedural changes within the department regarding coding and quality issues required by third-party payers and according to recommendations by coding consultants and agencies. Develops and coordinates educational and training programs on coding and documentation for department staff, physicians, billing staff and ancillary departments. Provides management with various statistical reports, data and audit information on health information management compliance issues, internal and external quality assurance results and activities, performance improvement activities and other statistical information as required or requested. Adapts to changing department demands required for higher department efficiency.   Requirements: Associate's degree or acceptable certification or graduation from an accredited school of nursing. CCS or CPC-H certification required. Two years coding experience in healthcare setting. Experience with 3M encoder and HBOC computer system. Ability to manage multiple projects simultaneously, and ability to respond quickly in a fast-paced environment. We offer: Competitive salaries Tuition reimbursement Low employee expense for medical and dental insurance 403(b) Savings and Retirement Program Easy commute from PA and major NJ routes. Find out why our 3000+ employees have chosen Capital Health. For more information and to apply online, please visit Equal opportunity employer.   Apply Here:   PI96630595

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