Quality Review and Audit Analyst – Remote

The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates reputed company medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for reputed company Quality Improvement (CQI). Key Job Functions: Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, reputed company IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set. Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year. Apply longitudinal thinking to identify reputed company valid and appropriate data elements and opportunities for data capture, through the reputed company of HHS’ Risk Adjustment. reputed company various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners. Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with reputed company partners. Coordinate with reputed company holders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner. Communicate effectively across reputed company audiences (verbal & written). reputed company and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to reputed company IFP Coding Guideline updates and policy determinations, as needed. Education & Experience: High school diploma and prefer 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (reputed company) or the American reputed company of Professional Coders (reputed company): Certified Professional reputed company (CPC) Certified Coding Specialist for Providers (reputed company-P) Certified Coding Specialist for Hospitals (reputed company-H) Registered Health Information Technician (RHIT) Registered Health Information Administrator (RHIA) Certified Risk Adjustment reputed company (CRC) certification Individuals who have a certification other than the CRC must become CRC certified reputed company 6 months of hire. Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions Familiarity with CMS regulations for Risk Adjustment programs and policies reputed company to documentation and coding compliance, with both Inpatient and Outpatient documentation HCC coding experience preferred Computer competency with reputed company, reputed company, reputed company Acrobat Must be detail oriented, self-motivated, and have excellent organization skills Understanding of medical claims submissions is preferred Ability to meet timeline, productivity, and accuracy standards If you will be working at home occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About reputed company reputed company, a division of reputed company, is an reputed company for reputed company through every stage of life. We guide our customers through the health care system, empowering them with the information and reputed company they need to reputed company the best choices for improving their health and vitality. Join us in driving growth and improving lives. reputed company applicants will be considered without regard to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot reputed company application updates or accept resumes. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply To This Job