Risk Adjustment Consultant

📋 Description

• Conducts continuous audits of medical records for our LCO groups and network providers to ensure the accuracy of diagnoses and CPT coding.

• Executes medical record audits to assess coding precision in accordance with CMS and DxCG regulations and standards.

• Reviews medical records for authorized providers, verifying face-to-face CPT codes, appropriate written and electronic signatures, and other technical requirements.

• Compiles and interprets audit results for the Director of Risk Adjustment Operations and NEQCA Leadership.

⛳️ Requirements

• Certified Risk Adjustment Coder (CRC) or must obtain certification within the first 12 months of employment.

• Minimum of two (2) years of experience in outpatient billing, coding, and risk adjustment.

• Associate’s degree is preferred.

• Certification as a Risk Adjustment Coder (CRC) is highly preferred.

• Two (2) years of experience in outpatient billing, coding, risk adjustment, and primary care adult medicine is preferred.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Paid time off

• Flexible work arrangements

• Professional development opportunities