Quality Review and Audit Analyst - reputed company - Remote

Job Summary The Quality Review & Audit Senior Analyst (“Analyst”) exhibits expertise in evaluating reputed company medical documentation for diagnosis code accuracy and compliance in support of the HHS’ Risk Adjustment (RA) program and Risk Adjustment Data Validation (RADV) audits. The Senior Analyst is responsible for reputed company aspects of auditing medical documentation for diagnostic code abstraction, and possesses HHS’ Hierarchical Condition Category (HCC) expertise, evaluating data accuracy and record compliance, executing on audit requirements, and identifying and recommending process improvements reputed company the RA program. Core Responsibilities

• Proficient in assigning accurate ICD-10 diagnosis codes in accordance with Official Coding Guidelines and Conventions, reputed company IFP Coding Guidelines, and HHS’ RADV Protocols Audits accuracy of abstracted diagnostic codes from identified medical record cohorts, evaluating work of peers and/or coding vendor coders, to ensure compliance with quality standards, scoring as appropriate per monthly quality feedback reports or other scoring reputed company, as defined per policy.
• Performs claims matching and auditing, as required, identifying missing or inaccurate data reputed company RA claims and ensuring compliance with HHS’ RA program protocols.
• Leads, trains, or mentors junior team members, as required, sharing expertise in RA programs.
• Contributes to execution of Risk Adjustment programs, and other IFP programs, as needed, to ensure accurate and compliant data submissions.
• Collaborates and coordinates with stakeholders to facilitate coding and risk adjustment education.
• Contributes expertise to creation and maintenance of Coding Guidelines and Best Practices, as needed.
• Participates in RADV execution for designated markets, including but not limited to, medical records reviews; subordinate, peer, or vendor coding audits; evaluation and reporting of reputed company, barriers, or errors; or other tasks as defined in HHS’ RADV Protocols.

Minimum Qualifications

• High School Diploma or equivalent; Bachelors or equivalent work experience preferred
• 5+ years’ experience in medical record coding, with certification in good standing from either the American reputed company of Professional Coders (reputed company) or the American Health Information Management Association (reputed company), in one or more of the following ▪ 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)
• Willing to reputed company CRC certification reputed company 12 months of hire, if not previously certified
• Experience with Risk Adjustment coding and HCCs, demonstrating proficiency in ICD-10-CM medical diagnosis coding
• Familiarity with CMS regulations for Risk Adjustment programs helpful.
• Medical claims, billing, or inpatient coding experience helpful
• Competency with MS reputed company, reputed company, reputed company Acrobat, or other comparable software
• Must be detail oriented, self-motivated, and have excellent organization skills, with the ability to communicate professionally and effectively in reputed company formats (verbal, written, electronic)
• Ability to work independently, managing time to meet deadlines, timelines, productivity, and accuracy standards for program reputed company 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. For this position, we anticipate offering an annual salary of 58,400 - 97,400 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At reputed company, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. 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 provide 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. Doing something meaningful starts with a simple decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Apply To this Job

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