Risk Adjustment Auditor

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

📋 Description

• Perform internal and external audits on the quality of ICD-10 code abstraction to ensure accuracy, completeness, and identify opportunities for clinical documentation improvement.

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

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

• Assist with potential CMS and HHS audits and the retrieval of medical records.

• Ensure that EDGE data is substantiated by provider encounter documentation.

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

• Uphold compliance with ICD-10-CM coding guidelines and Risk Adjustment production standards.

• Conduct audits for CMS Risk Adjustment Data Validation.

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

• Develop educational resources for providers to improve clinical documentation.

• Oversee process improvements aimed at maximizing increases in risk adjustment factors.

• Adhere to relevant laws and regulations.

• Carry out additional duties as assigned.

⛳️ Requirements

• Bachelor's degree in a related field or equivalent work experience.

• Certified Professional Coder (CPC).

• Over 3 years of experience in retrospective risk adjustment coding.

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

• Certified Risk Adjustment Coder (CRC) or a comparable certification.

• Proficient in coding across various Electronic Medical Record (EMR) systems.

🏝️ Benefits

• Comprehensive employee benefits.

• Unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.

• Reasonable accommodations during the application process.