Risk Adjustment Auditor

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

📋 Description

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

• Collaborate with management to establish benchmarks, acceptable thresholds, and quality assurance initiatives.

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

• Assist with potential CMS and HHS audits as well as medical record retrieval efforts.

• Confirm that EDGE data is backed by 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.

• Perform CMS Risk Adjustment audits, including RADV 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 risk adjustment factor increases.

• Report directly to the Manager of Risk Adjustment.

• Undertake additional duties as assigned.

⛳️ Requirements

• A bachelor's degree in a relevant field or equivalent work experience.

• Certified Professional Coder (CPC) certification.

• Over 3 years of retrospective risk adjustment coding experience.

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

• Candidates must reside in Arizona, Florida, Georgia, or Texas.

• Experience with various Electronic Medical Record (EMR) systems is a plus.

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

🏝️ 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 coverage.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.

• Occasional travel for team meetings and company events.