Risk Adjustment Coding Auditor

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

📋 Description

• Assesses risk adjustment codes to guarantee accuracy, consistency, and conformity with coding standards and best practices.

• Safeguards patient records and audit information by ensuring adherence to HIPAA, privacy, security, and regulatory standards.

• Conducts Retrospective and Prospective chart reviews to ensure precise risk adjustment reporting.

• Confirms and ensures the accuracy, completeness, specificity, and appropriateness of diagnosis codes reported by providers, based on medical record documentation.

• Analyzes medical record information to ensure complete and accurate capture of diagnosis codes in accordance with CMS HCC categories.

• Keeps abreast of relevant regulatory mandates and ensures that activities comply with established requirements.

• Contributes to audit and production efforts to fulfill business demands and manage workload priorities.

• Provides both written and verbal guidance on coding errors to colleagues.

• Achieves audit deliverables within set timelines and deadlines.

• Supports special projects, including risk mitigation reviews.

• Acts as a subject matter expert on the risk adjustment process and diagnosis coding for risk adjustment.

⛳️ Requirements

• A minimum of 7 years of relevant professional experience, considering all applicable experience including work, education, transferable skills, and military service.

• At least 5 years of HCC coding experience utilizing inpatient and outpatient coding guidelines.

• Minimum of 5 years of experience auditing Risk Adjustment records.

• Over 1 year of experience in a Production environment.

• Certification as a CRC (Certified Risk Coder) in good standing.

• Intermediate knowledge of risk adjustment models, including Medicare, ACA Commercial, and Medicaid.

• Proven ability to apply critical thinking skills to the interpretation and implementation of coding policies.

• Experience in providing written and verbal guidance regarding coding errors and trends.

• Proficient in MS Office (Word, Excel, PowerPoint, & Outlook) at an intermediate level or higher.

• Exceptional organizational skills to manage multiple projects within a deadline-driven environment.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

🏝️ Benefits

• Medical, dental & vision coverage.

• Critical Illness, Accident, and Hospital insurance.

• 401(k) Retirement Plan – Options for pre-tax and Roth post-tax contributions.

• Life Insurance (Voluntary Life & AD&D for employee and dependents).

• Short and long-term disability coverage.

• Health Spending Account (HSA).

• Transportation benefits.

• Employee Assistance Program.

• Paid Time Off/Leave (PTO, Vacation, or Sick Leave).