Senior Medical Quality Auditor – Risk Adjustment
GuideWell Source
full-time
Posted on:
Location Type: Remote
Location: Florida • United States
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Salary
💰 $71,200 - $89,000 per year
Job Level
About the role
- Execute audit procedures as outlined by Leadership including perform and document findings of quality accuracy reviews/quality audits of coding and documentation completed by Companies Internal Risk Adjustment Coders/Auditors to ensure consistency and accuracy of ICD-10 coding and industry standards.
- Advise Companies Internal Coders/Auditors on proper code selection, documentation guidelines as well as assist with training and education.
- Research and communicate ICD-10, Coding Clinics, and other industry standard guidance, when appropriate, for facilitating quality review findings and education.
- Perform and document findings of quality accuracy reviews/quality audits of coding and documentation completed by External Vendors, Partners and/or Provider Groups to ensure consistency and accuracy of ICD-10 coding.
- Communicate with external Vendors, Partners and/or Provider Groups to share out audit results and educational materials.
- Escalates trends in quality accuracy reviews/quality audits findings to Leadership and provide suggested corrective actions
- Assists Leadership and resources to support audit scope, deadlines, and objectives.
- Assist Leadership with improvements to the quality accuracy reviews/quality audits process, identifying risks, evaluating controls, and preparing documentation.
- Assists in developing, maintaining, and updating departmental procedures, workflows, and other work tools/job aides.
Requirements
- 4+ years related work experience or equivalent combination of transferable experience in Risk Adjustment Coding, Auditing, Coding Accuracy experience and/or Provider Education
- Related Bachelor’s degree or additional related equivalent work experience or equivalent work experience
- Demonstrated knowledge of CMS and HHS Risk Adjustment Programs Experience resolving escalated issues and barriers.
- Excellent communication and collaboration skills both with internal and external audiences
- Knowledge of health plan operations
- Knowledge of provider operations
- CRC (Certified Risk Adjustment Coder from AAPC) Upon Hire
- At least one of the following upon hire:
- - CPC (Certified Professional Code from AAPC)
- - COC (Certified Outpatient Coder from AAPC)
- - CIC (Certified Inpatient Coder from AAPC)
- - CCS (Certified Coding Specialist from AHIMA)
- - CCS-P (Certified Coding Specialists Physician Based from AHIMA)
Benefits
- Medical, dental, vision, life and global travel health insurance
- Income protection benefits: life insurance, short- and long-term disability programs
- Leave programs to support personal circumstances
- Retirement Savings Plan including employer match
- Paid time off, volunteer time off, 10 holidays and 2 well-being days
- Additional voluntary benefits available; and a comprehensive wellness program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
ICD-10 codingRisk Adjustment CodingAuditingCoding AccuracyProvider EducationQuality AuditsDocumentation GuidelinesQuality ReviewsCorrective ActionsWorkflow Development
Soft Skills
CommunicationCollaborationTrainingProblem SolvingLeadership SupportTrend AnalysisEducation FacilitationDocumentation PreparationRisk IdentificationControl Evaluation
Certifications
CRCCPCCOCCICCCSCCS-P