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

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

📋 Description

• Perform reviews and audits at both provider and coder levels to ensure that accurate risk adjustment data is submitted to CMS.

• Create and manage tracking tools for Risk Adjustment Compliance.

• Analyze audit outcomes and findings, and oversee corrective action plans.

• Supervise internal reporting to identify coding outliers.

• Stay updated on CMS audit processes and engage in risk adjustment audits.

• Oversee coding prevalence reports for outliers.

• Evaluate IPA policies and procedures to ensure program compliance.

• Assess the accuracy percentages of internal coding staff.

• Review the accuracy percentages of coding vendors and the quality of data 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, policies, and procedures.

• Monitor HCC Corrective Action Plans.

• Recommend customizations for Risk Adjustment education for support staff, providers, employees, contracted employees, and central departments.

• Handle patient PHI following HIPAA standards regarding use, protection, and disclosure.

• Enhance professional and technical knowledge through educational workshops, professional publications, networks, and professional societies.

• Act as a representative of the department during RADV and other risk adjustment audits.

• Execute additional duties as assigned.

⛳️ Requirements

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

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

• Certification as a coder is required - CPC, CCS & CCS-P.

• Experience with strategic planning aimed at risk mitigation.

• Proficient in using the MS Office suite.

• Excellent communication skills, both positive and professional, with the ability to lead, teach, and collaborate with others.

• Strong written and oral communication capabilities; able to build and maintain constructive relationships with diverse members, management, employees, and vendors.

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

• Ability to manage multiple tasks while utilizing advanced problem-solving skills to define issues, gather data, establish facts, draw valid conclusions, and design, implement, and oversee suitable resolutions.

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

• Ability to comprehend and analyze statistical reports.

• Must fulfill the physical demands of the role, which include talking, hearing, standing, walking, sitting, using hands and fingers, reaching, and frequently lifting or moving up to 10 pounds.

• Specific vision abilities required include close vision and the ability to adjust focus.

🏝️ Benefits

• Comprehensive health insurance plans.

• Retirement savings options with employer contributions.

• Professional development opportunities.

• Flexible work arrangements.

• Paid time off and holidays.