Quality Review and Audit Analyst

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

📋 Description

• Conduct thorough reviews of medical records while accurately abstracting diagnosis codes in line with Official Coding Guidelines and Conventions.

• Collaborate and coordinate with team members and cross-functional partners to enhance various aspects of coding and Risk Adjustment education.

• Execute diverse documentation and data audits, identifying gaps and/or inaccuracies in risk adjustment data.

• Communicate effectively with all audiences through both verbal and written means.

• Develop and implement internal program processes to ensure compliance with CMS/HHS regulations.

⛳️ Requirements

• High school diploma.

• A minimum of 2 years of experience in one of the following Coding Certifications from either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC): Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Risk Adjustment Coder (CRC) certification.

• Experience in conducting medical documentation audits and reviewing medical charts.

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

• Familiar with CMS regulations pertaining to Risk Adjustment programs and policies regarding documentation and coding compliance.

• Understanding of medical claims submissions is preferred.

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

• Must be detail-oriented, self-motivated, and possess excellent organizational skills.

🏝️ Benefits

• Health insurance.

• Vision insurance.

• Dental insurance.

• 401(k).

• Company-paid life insurance.

• Tuition reimbursement.

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

• Paid holidays.

• Leaves of absence.