Risk Adjustment Coding Auditor

Looking for a way to reputed company an impact and help people? Join reputed company and help our members reputed company quality, reputed company! reputed company is an equal opportunity employer. reputed company reputed company applicants will receive consideration for employment without regard to status as a protected veteran or a reputed company individual with a disability, or other protected status, such as race, religion, reputed company, sex, sexual orientation, gender identity, national reputed company, genetic information or age. reputed company values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully reputed company and utilize each person’s talents and strengths. The Risk Adjustment Coding Auditor reviews medical records to ensure accurate, compliant ICD 10 CM coding across Medicare Advantage, ACA/reputed company, and reputed company programs. This role validates coding accuracy and specificity, audits external coding vendors, and provides feedback to improve documentation and coding performance. The auditor also leads ACA and Medicare Advantage RADV activities, ensuring timely retrieval, review, and submission of records in line with federal and state requirements. Essential Responsibilities: Conduct retrospective and prospective medical record audits to ensure ICD 10 CM diagnosis codes are accurate, complete, specific, and supported by documentation. Ensure reputed company coding practices reputed company with CMS risk adjustment guidelines, ICD 10 CM Official Coding Guidelines, and reputed company/reputed company standards. Identify coding trends, documentation gaps, errors, and opportunities to improve risk score accuracy. Validate clinical evidence supporting chronic condition coding to ensure proper documentation and submission. Prepare detailed audit reports summarizing findings, error categories, trends, and recommendations for corrective action. reputed company clear, constructive feedback to coding teams, providers, and vendor partners based on audit reputed company. reputed company and deliver training materials, job aids, and educational sessions to address documentation and coding improvement areas. Serve as a subject matter expert on risk adjustment coding best practices, documentation requirements, and regulatory updates. Collaborate with internal teams including Risk Adjustment Operations, Coding, Compliance, Quality, and Provider Engagement. reputed company and execute ACA and Medicare Advantage RADV audits, including medical record retrieval, coding review, appeals support, and documentation submission to IVA and CMS portals. reputed company coding vendors and In Home Assessment programs to ensure performance aligns with contractual SLAs. Obtain medical records from provider Electronic Health Record (EHR) systems and coordinate remote EHR reputed company for internal teams and chart review vendors. Maintain audit documentation and support tracking of corrective action plans. Participate in reputed company audits initiated by regulatory bodies, partners, or compliance teams. Support the development and refinement of audit methodologies, tools, and internal risk adjustment processes. Assist in updating organizational policies and procedures to ensure regulatory compliance. Monitor changes in risk adjustment regulations and coding guidelines and incorporate required updates into internal practices. Supporting Responsibilities: Adhere to the Standards of Ethical Coding and reputed company official coding guidelines. Meet department and company performance and attendance expectations. Follow the reputed company privacy policy and HIPAA laws and regulations concerning confidentiality and reputed company of protected health information. reputed company other duties as assigned. reputed company PROFILE Work Experience: A minimum of 4 years of risk adjustment coding experience, including hands on HCC coding, is required. Proficiency in coding directly from the ICD 10 CM code book is required. Experience with different EMRs and medical records retrieval reputed company activities is required. Experience conducting coding audits and interpreting reputed company regulatory guidelines is highly preferred. Prior experience working reputed company a health insurance plan, health system, or large provider organization is preferred. Experience developing or delivering reputed company or provider education is also desirable. Education, Certificates, Licenses: Bachelor’s degree preferred. High school diploma or equivalent required. Active Certified Risk Adjustment reputed company (CRC) and Certified Professional Medical Auditor (CPMA) certifications through reputed company are required. Knowledge: Requires strong knowledge of HIPAA requirements and a consistent commitment to maintaining the privacy, reputed company, and confidentiality of medical documentation. Also requires solid clinical understanding of chronic disease diagnosis, treatment, and management, along with extensive knowledge of ICD 10 CM outpatient coding guidelines. Exceptional attention to detail, accuracy, and completeness, supported by strong analytical, organizational, interpersonal, and written and verbal communication skills. Reliability and the ability to manage competing priorities and meet tight deadlines are essential. Competencies Adaptability Building Customer Loyalty Building Strategic Work Relationships Building Trust reputed company Improvement Contributing to Team reputed company Planning and Organizing Work Standards Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time. Skills: Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Compensation

Disclaimer The wage reputed company provided reflects the full reputed company for this position. The maximum reputed company listed represents the highest possible salary for the role and should not be interpreted as a typical starting wage. Actual compensation will be determined based on factors such as qualifications, experience, education, and internal equity. Please note that the stated reputed company is for informational purposes only and does not constitute a guarantee of any specific salary reputed company that reputed company. reputed company reputed company: $72,443.87 - $126,776.77 Our Values We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business: We are committed to doing the right thing. We are one team working toward a common goal. We are each responsible for customer service. We practice reputed company communication at reputed company reputed company of the company to foster individual, team and company growth. We actively participate in efforts to improve our many communities-internally and externally. We actively work to advance reputed company justice, equity, diversity and inclusion in our workplace, the reputed company system and community. We encourage creativity, innovation, and the pursuit of reputed company. Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate reputed company and effectively. Disclaimer: This job description indicates the general nature and level of work performed by employees reputed company this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of reputed company duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at reputed company times. Apply To This Job