Risk Adjustment Auditor

This is a fully remote position, open to applicants in Arizona, +2 more states.

📋 Description

• Carry out internal and external quality audits of ICD-10 code abstraction to ensure accuracy, thoroughness, and identify opportunities for clinical documentation improvement.

• Collaborate with management to set benchmarks, define acceptable thresholds, and develop quality assurance programs.

• Execute medical record reviews and document ICD-10-CM diagnosis codes for ACA and MA lines of business.

• Assist in potential CMS and HHS audits as well as medical record retrieval initiatives.

• Confirm that EDGE data is substantiated within provider encounter documentation.

• Analyze the performance of the Risk Adjustment Coding team and communicate audit trends to Leadership.

• Ensure adherence to ICD-10-CM coding guidelines and maintain Risk Adjustment production standards.

• Conduct CMS Risk Adjustment Data Validation audits.

• Foster relationships to enhance understanding of the Risk Adjustment process.

• Develop resources for clinical documentation improvement aimed at provider education.

• Oversee process enhancements to optimize increases in risk adjustment factors.

• Adhere to relevant laws and regulations.

⛳️ Requirements

• A bachelor's degree in a pertinent field of study or equivalent work experience.

• Certified professional coder (CPC) certification.

• A minimum of 3 years of retrospective risk adjustment coding experience.

• At least 1 year of experience in Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV).

• Experience with coding across various Electronic Medical Record (EMR) systems is advantageous.

• Certified Risk Adjustment Coder (CRC) or similar certification is a plus.

🏝️ Benefits

• Employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• 401(k) plan participation.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.

• Reasonable accommodations during the application process.