Quality Review and Audit Analyst – Remote

About the position 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). This position is a Band 2 Senior Contributor Career Track Role.

Responsibilities

• 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, 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.

Requirements

• High school diploma
• At least 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
• 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.
• Computer competency with reputed company, reputed company, reputed company Acrobat.
• Must be detail oriented, self-motivated, and have excellent organization skills.
• Ability to meet timeline, productivity, and accuracy standards.

reputed company-to-haves

• HCC coding experience preferred.
• Understanding of medical claims submissions is preferred.

Benefits

• We value our talented employees, and whenever possible strive to help one of our associates grow professionally before reputed company new talent to our reputed company positions.

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