Risk Adjustment Coding Auditor
DaVita Kidney Care
full-time
Posted on:
Location Type: Remote
Location: Texas • United States
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Salary
💰 $57,784 - $85,000 per year
About the role
- Auditing, Analysis, and Compliance
- Ensure that IKC is compliant with industry regulations and published coding guidelines
- Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes
- Perform detailed internal and external coding audits on a regular basis as defined by compliance requirements
- Execute targeted audit plans, including performing targeted audits of identified HCC outliers
- Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings
- Prepare and present formalized audit reports to leadership
- Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits
- Perform necessary research to provide supportive regulatory and coding guideline documentation
- Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines
- Provide one-on-one and group education sessions based on audit findings
Requirements
- Current coding certification from AAPC or AHIMA is required
- 3+ years of coding experience
- 2-3 years’ minimum recent experience performing medical audits for diagnosis coding
- Strong computer skills, including the ability to utilize various EMR systems and Microsoft Office
- Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models
- Deep understanding of coding and documentation compliance, including CMS and HHS regulations
- High school diploma or equivalent required
- Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred
Benefits
- Medical, dental, vision
- 401(k) match
- Paid time off
- PTO cash out
- Family resources
- EAP counseling sessions
- access Headspace ®
- backup child and elder care
- maternity/paternity leave
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10-CMcoding auditsdata analysisrisk adjustmentdocumentation improvementmedical codingcompliance auditingcoding guidelinesHCC outliersinsurance rules
Soft Skills
presentation skillstraining deliveryeducational material developmentanalytical thinkingattention to detailcommunication skillsproblem-solvingteam collaborationleadershiporganizational skills
Certifications
AAPC coding certificationAHIMA coding certification