Quality Review and Audit Analyst

📋 Description

• Conduct reviews of medical records with precise abstraction of diagnosis codes.

• Utilize HHS’ Risk Adjustment Model effectively.

• Apply a longitudinal perspective to pinpoint essential data elements.

• Execute documentation and data audits thoroughly.

• Collaborate with team members and matrix partners efficiently.

• Coordinate with stakeholders to ensure streamlined Risk Adjustment programs.

• Communicate clearly and effectively.

• Develop and implement internal processes for program management.

⛳️ Requirements

• High school diploma or equivalent.

• Minimum of 2 years of experience in medical coding.

• Coding Certifications from AHIMA or AAPC: CPC, CCS-P, CCS-H, RHIT, RHIA, CRC.

• Experience in conducting medical documentation audits and chart reviews.

• Proficient in ICD-10-CM coding guidelines and conventions.

• Familiarity with CMS regulations regarding Risk Adjustment programs.

• Competent in computer applications including Excel, MS Word, and Adobe Acrobat.

• Detail-oriented, self-driven, and possesses exceptional organizational skills.

• Understanding of medical claims submissions is preferred.

• Ability to meet deadlines, productivity, and accuracy standards.

🏝️ Benefits

• Medical, vision, dental, along with well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement available.

• A minimum of 18 days of paid time off annually.

• Paid holidays.