Growing Need for RADV Professionals

Posted by Doug Smith on May 24, 2017 1:11:00 PM

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This blog post is the first in a series covering topics within the Healthcare industry.

A common misconception about healthcare staffing is that it typically only places nurses and healthcare professionals who work in hospitals. While those are important segments of the business, there are many other areas of healthcare relying on a contingent workforce; including managed care organizations. One emerging vertical within the managed care space currently seeing a lot of attention is Risk Adjustment Data Validation (RADV).

What exactly is RADV? The Centers for Medicare and Medicaid Services (CMS) perform RADV audits on patient’s medical records. This process verifies diagnosis codes submitted for payment and the purpose is to ensure risk adjusted payment integrity and accuracy. The overall goal of RADV is to reduce payment errors and companies are putting a lot of emphasis on this. One of the driving reasons behind this emergence is the fact that if CMS finds that an organization received overpayments, they will be responsible for paying CMS back.

Some of you may have noticed that there is a growing need for HCC coders across the country. It is extremely important for health plans to have accurate coders on their staff; as accurate HCC coding is crucial for RADV to determine enrollee risk scores. A lot of companies allow these coders to work from home or have flexible hours and they are willing to pay a premium price for them because of the value they provide! CMS then comes in and does RADV audits to validate the accuracy of the HCC codes submitted by the plans for payments. In an effort to avoid any issues with CMS, the health plans are investing a lot of time, money, and effort into their own internal RADV audits to mitigate risk.

Who hires coders? Almost every healthcare company in the country is hiring coders —Hospitals, long term care, home health, etc. However, the companies hiring the most coders and RADV professionals are the health insurance companies and specialized IT firms that are focused around providing technology that enables the assessment and improvement of clinical and quality outcomes.

What qualifications do coders and RADV candidates’ need? Part of the reason for the surge in hiring coders is because it has become increasingly accessible to obtain certification. You do not need to have a college degree, you just need to take and pass a coding certification test. Most coders go through a coding certificate program which trains them and prepares them for the test.

RADV talent is an increasingly sought after set of healthcare professionals. With the ever-increasing scrutiny being placed on healthcare companies, these professionals are proving to be must-have staff members.

 

Doug Smith is the Director of Healthcare in the DC Metro area. As one of a small handful of healthcare talent solutions providers, Doug and his team have the expertise and professionals to meet the growing demand for RADV, nursing, and other healthcare professionals. They are excited to work with clients to help protect their businesses when it comes to RADV and to anticipate client’s needs as they evolve with the ever changing healthcare and technology space.

 

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Topics: Risk Adjustment Data Validation, Healthcare, RADV