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About the role
- Risk Adjustment Auditor managing retrospective and prospective chart reviews for accurate risk adjustment reporting. Collaborating with education consultants and ensuring compliance with coding guidelines.
Responsibilities
- Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
- Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
- Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
- Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
- Supports and actively participates in process and quality improvement initiatives.
- Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
- Consistently meets departmental performance and attendance requirements.
- Serves as a mentor to Risk Adjustment Auditor I staff.
- Assists with special projects such as risk mitigation reviews.
- Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
- Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program.
- Assists with implementation activities as a result of regulatory changes to the Program.
Requirements
- Associate degree in Healthcare or related field
- Three years of experience in clinical coding or auditing or equivalent combination of education and experience.
- Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required.
- RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.
- Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
- Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.
- Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
- Demonstrated ability to identify and communicate trends in provider coding and documentation.
- Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
- Effective verbal and written communication skills.
- Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
- Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
- Demonstrated ability to provide proactive and creative solutions to business problems.
Benefits
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
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