Quality Review & Audit Analyst

Role Overview

• Conduct medical records reviews with accurate diagnosis code abstraction
• Utilize HHS’ Risk Adjustment Model to confirm accuracy of HCC
• Apply longitudinal thinking to identify valid data elements
• Perform various documentation and data audits
• Collaborate and coordinate with team members and matrix partners
• Coordinate with stakeholders to execute efficient RA programs
• Communicate effectively across all audiences
• Develop and implement internal program processes ensuring compliance with CMS/HHS

Requirements

• High school diploma
• At least 2 years’ experience in 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
• Detail oriented and self-motivated
• Excellent organization skills
• Understanding of medical claims submissions is preferred

Benefits

• Medical, vision, dental insurance
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• Minimum of 18 days of paid time off per year
• Paid holidays