Risk Adjustment Auditor

Role Overview

• Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries.
• Assist with validation audits to evaluate medical record documentation, to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code.
• Submit documentation to CMS for reimbursement and interpretation of medical documentation, to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
• Attention to detail while reviewing patient’s clinical record.
• Ensure regulatory compliance, and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC.

Requirements

• Associate's Degree, LPN/RN
• Associates Degree
• Required or Certificate, Medical Assisting
• Required
• 3 years experience in the Medical Field
• Required
• 1 year Coding experience
• Preferred
• Certified Medical Assistant (CMA)
• American Association of Medical Assistants (AAMA)
• Required or Licensed Practical Nurse (LPN)
• State Licensing Board
• Required or Registered Nurse (RN)
• State Licensing Board
• Required

Benefits

• Comprehensive benefit offerings