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VARIS LLC
Alabama, United States
1 day ago

Description

What Are You Looking For?

A sense of "team" in a remote environment?

A high level group of colleagues to interact with that are focused on coding accuracy?

A company that recognizes individual contribution?

An opportunity to be self-directed and have flexibility?

A supportive workplace with opportunities for growth and promotion?

The best place you will ever work?

VARIS LLC, an industry leader in recovery auditing, assist health plans of all scopes and sizes recover overpayments made within the inpatient DRG and outpatient APC claims payments.

VARIS is looking for self-motivated, conscientious and responsible coding professionals to join our team.  VARIS prides itself on the professionals that we hire, as well as the service we provide to our clients and the quality results we produce.  We are looking for coding professionals throughout the United States who maintain a RHIA, RHIT, CCS and/or CPC certification.  VARIS offers all coding professionals the opportunity to work remotely with some travel required.  Opportunities are available for on-site work.  VARIS' benefits are highly competitive and rewarding including but not limited to: 10 paid holidays, 401 K with company contribution, generous paid time off (determined by previous experience), profit sharing, educational opportunities and compensation, flexible schedules and incentivized for travel projects. 

Join the VARIS Team, where you are not just an employee but part of the close knit organization!  Promoting success and increasing knowledge is a priority of VARIS, we want our employees to become the best of the best. 

RESPONSIBILITIES:

  • Leads the Clinical Validation program assuring systems, staffing and procedures are producing excellent identification services.
  • Develops detailed queries and works closely with IT for accurate numeric results for projection and evaluation.
  • Reviews multiple resources for clinical validation diagnosis and criteria, including the independent peer review organization (IPRO).
  • Analyzes data and identifies target diagnosis which clinical criteria can be applied for validation.
  • Works closely with the IPRO in the development and selection of clinical criteria sources.
  • Develops criteria checklist for each diagnosis selected for screening internally and for transmission of data to the IPRO when cases do not meet the criteria.
  • Provides formal presentation dually with IPRO on each proposed diagnosis and associated clinical criteria to the client and answer questions regarding the clinical validation process.
  • Coordinates with health plans to obtain diagnosis and clinical criteria approvals. Upon approval add them to the program, as appropriate and educate staff. 
  • Ensures clinical validation is completed by clinician for cases being referred to independent peer review organization.
  • Ensures open communication with the IPRO Medical Director on reviews, appeals, feedback, etc.
  • Evaluates outcomes daily, weekly and monthly based upon return on investment (ROI).
  • Coordinates adequate staffing and mentor the staff to achieve excellent quality of work in collaboration with the CVS Manager.
  • Provides education and training with the goal of improving performance.
  • Conducts quality assurance audits and works with staff and CVS Manager as needed.
  • Works closely with the CVS Manager regarding staffing needs, quality, etc.
  • Develops and maintains written CV policies and procedures.
  • Assists in developing potential enhancements or changes in diagnosis or queries to improve CV performance.
  • Works with the Contract Administrators and BDT to assure that CV services are promoted with clients and potential clients
  • Represents VARIS CV program with independent peer review organization, clients and providers.
  • Coordinates internal and external meetings (IPRO) and takes minutes of these meetings.
  • Performs or assists with special projects as needed.
  • Other duties as assigned.


Requirements

QUALIFICATIONS:

  • Experienced as a team leader in achieving successful business results
  • Clinical education as a nurse, physician or clinical documentation improvement specialist.
  • Experience in data analytics to assist with decision making.
  • Excellent positive communication skills both verbal and written.  Can confidently make presentations focusing on clinical criteria and new diagnoses to new and existing clients, specifically, health plan clinical staff.
  • Proven self-direction in planning and execution of performing and understanding multiple processes and procedures. 
  • Organization, flexibility and multiple task/project orientation to handle duties assigned.
  • Skill in focusing on desired results, determining what is important and urgent, clarifying next steps, and delegating effectively to meet deadlines and achieve desired results
  • Demonstrated professional conduct and judgement. 
  • Ability to adhere to the highest ethical standards including honesty, integrity, dedication and leadership
  • Demonstrated proficiency in multiple computer applications (MS Office).
  • National certification as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), and/or Certified Coding Specialist (CCS) / Certified Professional Coder (CPC).  Additional coding or auditing certifications as required per the job description may imply. 
  • Comprehensive knowledge of the IPPS or OPPS reimbursement structure and other health care payment methodologies and regulatory requirements.
  • Minimum of five to seven years hospital inpatient or outpatient coding experience OR a minimum of 2 years’ experience performing DRG or APC coding validation complex reviews.
  • Performs other duties or projects as assigned.
  • Must be able to travel as needed.

Job Information

  • Job ID: 54795192
  • Location:
    Alabama, United States
    Alaska, United States
    Arizona, United States
    Arkansas, United States
    California, United States
    Colorado, United States
    Connecticut, United States
    Delaware, United States
    Dist. Columbia, United States
    Florida, United States
    Georgia, United States
    Hawaii, United States
    Idaho, United States
    Illinois, United States
    Indiana, United States
    Iowa, United States
    Kansas, United States
    Kentucky, United States
    Louisiana, United States
    Maine, United States
    Maryland, United States
    Massachusetts, United States
    Michigan, United States
    Washington, United States
    West Virginia, United States
    Wisconsin, United States
    Wyoming, United States
    Rhode Island, United States
    South Carolina, United States
    South Dakota, United States
    Tennessee, United States
    Texas, United States
    Utah, United States
    Vermont, United States
    Virginia, United States
    Minnesota, United States
    Mississippi, United States
    Missouri, United States
    Montana, United States
    Nebraska, United States
    Nevada, United States
    New Hampshire, United States
    New Jersey, United States
    New Mexico, United States
    New York, United States
    North Carolina, United States
    North Dakota, United States
    Ohio, United States
    Oklahoma, United States
    Oregon, United States
    Pennsylvania, United States
  • Position Title: Clinical Validation Coordinator
  • Company Name: VARIS LLC
  • Industry: Ambulatory Care,Remote
  • Job Function: Academic Administrator,
    Auditing
  • Job Type: Full-Time
  • Job Duration: Indefinite
  • Min Education: HIM Certificate Program/ISP
  • Min Experience: 5-7
  • Required Travel: 10-25%
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