Risk Adjustment Auditor

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

📋 Description

• Perform audits on coding, documentation, and validation of medical records and clinical data for risk adjustment vendors and other specified groups.

• Examine patient medical records, which include physician notes, lab results, and diagnostic reports, to pinpoint relevant diagnoses and gather essential data for precise coding.

• Assign the correct ICD-10 codes to accurately document and reflect patient conditions, ensuring adherence to coding guidelines and regulations.

• Remain informed about updates in HIPAA protocols, coding guidelines, regulations, and compliance standards.

• Achieve team performance goals regarding the volume of work accomplished and quality of audit scores.

• Execute RADV/IPM Chart Review responsibilities as assigned.

• Occasionally engage in the Coding Advisory Committee.

⛳️ Requirements

• An associate's degree or a combination of relevant education and experience.

• Over 5 years of experience in clinical coding.

• Background in risk adjustment coding.

• Certified Coder (CPC/COC) or Certified Risk Coder (CRC) certification is mandatory.

• Proficient knowledge of ICD-9/10-CM, CPT, and other specialty coding guidelines.

• Solid understanding of medical terminology and chronic disease management.

• Strong auditing capabilities specific to Medicare Risk Adjustment.

• Exceptional written and verbal communication skills.

• Strong problem-solving abilities.

• Excellent organizational skills.

• Capacity to connect with diverse individuals and foster constructive and effective relationships.

• Ability to work independently with minimal oversight.

• This position is not eligible for immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Additional employee benefits.

• Incentive or commission-based programs may be available, where applicable.