Auditing, Analysis, and Compliance
Ensure that IKC is compliant with industry regulations and published coding guidelines
Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes
Perform detailed internal and external coding audits on a regular basis as defined by compliance requirements
Execute targeted audit plans, including performing targeted audits of identified HCC outliers
Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings
Prepare and present formalized audit reports to leadership
Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits
Perform necessary research to provide supportive regulatory and coding guideline documentation
Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines
Provide one-on-one and group education sessions based on audit findings

Current coding certification from AAPC or AHIMA is required
3+ years of coding experience
2-3 years’ minimum recent experience performing medical audits for diagnosis coding
Strong computer skills, including the ability to utilize various EMR systems and Microsoft Office
Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models
Deep understanding of coding and documentation compliance, including CMS and HHS regulations
High school diploma or equivalent required
Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred

Risk Adjustment Coding Auditor

Key skills