Job Title: Risk Adjustment Coding Auditor

Highlights: Very investigative person who is reviewing the codes, looking for trends and mistakes and will be auditing thousands of pages of medical records. They need to have really strong RA experience and it is ideal if they have experience with a CMS Audit. This is a senior role and they need to have a CRC or another cert from the AAPC or another area.

Position Summary: The Coding Auditor conducts coding audits to ensure that medical diagnostic codes submitted to CMS (Centers for Medicare and Medicaid Services), and other entities are accurate based on the practitioners' medical record documentation of members' health conditions.

Duties & Responsibilities:

• Audits data, claim submissions, and member medical records for completeness, accuracy, and compliance with the company's policy and documents findings per departmental procedure
• Identifies patterns of under-performance, noncompliance, and inconsistencies and recommends resolutions
• Evaluates the quality of medical coding and notifies management of discrepancies, as needed.
• Conducts internal audits of medical record reviews performed by colleagues
• Review of multi-specialty medical records to determine the substantiation of medical conditions
• Well versed on CMS Risk Adjustment Protocols
• Review clinical documentation using M.E.A.T or T.A.M.P.E.R.E.D criteria
• Collaborates with other departments to improve compliance with coding conventions and clinical practice guidelines
• Supports continuous improvement and quality initiatives to improve processes across departments.

Minimum Qualifications:

• Coding certification from either American Academy of Professional Coders (AAPC)
• CRC certification or American Health Information Management Association (AHIMA) CCS-P or CCS certification.
• High school diploma or GED.

Preferred Qualifications:

• Previous relevant experience in a healthcare setting
• Time management, critical/creative thinking, communication, and problem-solving skills
• Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment
• Demonstrated professional writing, electronic documentation, and assessment skills.
• Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.
• Knowledge of ICD10 and anatomy and pathophysiology medical terminologies.

Pay: $28-40/hr DOE

Location: 100% remote