Quality Review and Audit Analyst – Individual & Family Plans

Role Overview

• conduct medical records reviews with accurate diagnosis code abstraction
• utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
• apply longitudinal thinking to identify data elements for capture
• perform documentation and data audits identifying gaps and compliance risks
• collaborate with team members and partners for coding education
• coordinate with stakeholders for compliant RA programs
• communicate effectively across all audiences
• develop and implement internal program processes

Requirements

• high school diploma
• at least 2 years’ experience in medical coding
• coding certifications (CPC, CCS-P, CCS-H, RHIT, RHIA, CRC)
• experience with medical documentation audits and medical chart reviews
• proficiency with ICD-10-CM coding guidelines and conventions
• familiarity with CMS regulations for Risk Adjustment programs
• HCC coding experience preferred
• computer competency with excel, MS Word, Adobe Acrobat
• must be detail oriented, self-motivated, and have excellent organization skills
• understanding of medical claims submissions preferred
• ability to meet timeline, productivity, and accuracy standards

Benefits

• medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays