Senior Quality Review and Audit Analyst – RADV

Role Overview

• Responsible for coordination and implementation of daily processes related to IFP Risk Adjustment programs
• Liaising with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes
• Coordinating with Quality Mgmt to effectively and compliantly execute daily RA program operations
• Participating in coding reviews of medical documentation for RA programs
• Communication and reporting of daily productivity and risks associated with IFP RADV audits

Requirements

• High School Diploma
• 5+ year’s Risk Adjustment experience
• Certification by AHIMA or AAPC in CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC
• Experience with medical audits
• Proficiency with ICD-10-CM coding and guidelines
• Familiarity with CMS regulations and policies related to documentation and coding
• HCC coding experience preferred
• Computer competency with Excel, MS Word, Adobe Acrobat
• Detail oriented, self-motivated, and excellent organization skills

Benefits

• Health insurance
• Vision insurance
• Dental insurance
• Well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays