Risk Adjustment Auditor

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

📋 Description

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

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

• Conduct reviews of medical records and report ICD-10-CM diagnosis codes for ACA and MA lines of business.

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

• Ensure that EDGE data is adequately supported by provider encounter documentation.

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

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

• Carry out CMS Risk Adjustment Data Validation audits.

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

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

• Oversee process enhancements to optimize risk adjustment factor increases.

• Adhere to relevant laws and regulations.

⛳️ Requirements

• Bachelor’s degree in a relevant discipline or equivalent work experience.

• Certified Professional Coder (CPC) certification.

• Over 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).

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

• Familiarity with coding in diverse Electronic Medical Record (EMR) systems is advantageous.

🏝️ Benefits

• Comprehensive employee benefits package.

• Unlimited vacation policy.

• Annual performance bonuses.

• Medical benefits coverage.

• Dental benefits coverage.

• Vision benefits coverage.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life and disability insurance options.

• Paid wellness time and reimbursement opportunities.