Senior Risk Adjustment Coding Auditor

Role Overview

• Perform and lead a variety of coding-related audits for providers and other entities
• Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data
• Communicate audit results and recommendations for improvement to providers when needed
• Create and maintain processes for tracking audit results and outcomes of reviews
• Identify, track, analyze and report on any trends revealed in audits
• Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders
• Lead the development of educational materials and process documentation in a variety of mediums
• Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations
• Maintain active coding certification
• Seek out emerging coding best practices
• Serve as subject matter expert regarding correct coding practices
• Collaborate with Risk Adjustment team to create SOPs and contribute to roadmaps for Risk Adjustment Coding initiatives
• Onboard and train new Coding Auditors

Requirements

• Minimum 5 years’ experience as a certified coder
• Current coding certification from AHIMA or AAPC
• One-year experience with risk adjustment program in a Health Plan
• Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO) preferred
• Experience leading group educational presentations and teaching to medical professionals
• 5 years’ experience with CMS, HHS and/or CDPS+RX Hierarchical Condition Categories (HCC) models
• Experience with or knowledge of risk adjustment principles

Benefits

• Health insurance
• Dental coverage
• Vision insurance
• Life insurance
• AD&D insurance
• Disability insurance
• Health savings account
• Flexible spending account(s)
• Lifestyle spending account
• Employee assistance program
• Wellness program
• Discounts and supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
• Retirement plan with employer contributions
• Paid time off (PTO) and Paid State Sick Time based on hours worked
• Paid holidays, volunteer time, jury duty, and bereavement leave