Medicare Risk Adjustment Coding Auditor, Certified Risk Adjustment Coder

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in conducting regular quality assurance audits for the internal Coding Analyst team to ensure coding and abstracting quality while achieving a 95% HCC accuracy standard.

• Monitor and report the progress of quality assurance audits carried out on coding vendors.

• Confirm the accuracy of coding and the quality of data submitted to Alignment Health for CMS submissions.

• Collaborate with Risk Adjustment Management on MRA data validation and coding audits.

• Examine data for reconciliation, data-flow integrity, UAT testing, high-cost/low-risk-score members, retrospective chart reviews, and other risk-adjustment-related tasks.

• Analyze and communicate audit findings with the Manager.

• Facilitate training for physicians and clinical staff, enhance documentation, and improve systems/processes using insights from audit results.

• Safeguard, utilize, and share patient PHI in accordance with HIPAA regulations.

• Ensure adherence to relevant regulations and organizational policies and procedures.

• Keep professional and technical knowledge updated and stay informed on coding, compliance, and HCC topics.

• Perform additional responsibilities as assigned.

⛳️ Requirements

• At least three years of experience in Medicare Risk Adjustment coding within a medical group or health plan environment.

• High School Diploma or GED.

• Completion of a Medical Coding training program.

• Technical education or courses necessary for certification as a coder.

• Certification as a Coder is required: CCS, CCS-P, CPC, or CRC.

• Proficient in MS Office Suite – Excel, Word, Outlook.

• Prior experience with Epic, Allscripts, and EZCap.

• Strong written and verbal communication skills.

• Capable of providing leadership, teaching, and collaborating effectively with others.

• Ability to build and maintain positive relationships with diverse members, management, employees, and vendors.

• Competence in performing mathematical calculations and accurately calculating simple statistics.

• Advanced problem-solving and reasoning abilities.

• Capacity to prioritize multiple tasks and thrive in a fast-paced environment.

• Ability to understand and analyze statistical reports.

• Commitment to complying with HIPAA and relevant federal, state, and local regulations.

• Must maintain relevant CEUs for individual coding certifications.

🏝️ Benefits

• Significant opportunities for growth and innovation.

• Continuing education and professional development through workshops, professional publications, personal networks, and professional associations.

• Continuing education units (CEUs) applicable to coding certifications.

• Reasonable accommodations provided for individuals with disabilities.

• Commitment to equal employment opportunity.