Medicare Risk Adjustment Compliance Auditor, CPC, CCS, CCS-P

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

📋 Description

• Perform reviews and audits at both the provider and coder levels to guarantee accurate risk-adjustment data submissions to CMS.

• Create and sustain tracking tools for Risk Adjustment Compliance.

• Evaluate and audit outcomes and findings.

• Oversee corrective action plans that arise from review or audit findings.

• Supervise internal reporting for coding outliers.

• Assess IPA policies and procedures for compliance.

• Track accuracy percentages of internal coding personnel.

• Review the accuracy and data quality from coding vendors submitted to CMS.

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

• Ensure adherence to relevant federal, state, and local regulations as well as organizational standards.

• Propose tailored Risk Adjustment education for support staff, providers, employees, vendors, and departments.

• Manage protected health information in line with HIPAA standards.

• Represent the department during RADV and other risk-adjustment audits.

• Keep up-to-date with professional and technical knowledge through continuous education and professional activities.

⛳️ Requirements

• At least 3 years of professional coding experience within a medical group or health plan environment.

• Bachelor’s degree in business administration, health care management, or a related field, or 4 additional years of experience in place of education.

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

• Experience in strategic planning for risk mitigation.

• Proficient in using MS Office Suite.

• Capable of communicating positively, professionally, and effectively; able to provide leadership, teach, and collaborate.

• Strong written and oral communication skills.

• Ability to establish and maintain constructive relationships with diverse members, management, employees, and vendors.

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

• Skilled in prioritizing multiple tasks and employing advanced problem-solving and reasoning abilities.

• Excellent problem-solving, organizational, and time-management skills; capable of thriving in a fast-paced environment.

• Proficient in comprehending and analyzing statistical reports.

🏝️ Benefits

• Comprehensive health insurance plans.

• Opportunities for professional development and growth.

• Flexible work policies to promote work-life balance.