Outpatient Coding Auditor
Affordable Housing Trust for Columbus and Franklin County
Individual & Family Plans – Quality Review and Audit Manager
The Cigna Group
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $89,000 - $148,300 per year
Job Level
Mid-LevelSenior
About the role
- Manage day-to-day performance of a team of coding auditors (~8) within Individual and Family Plans (IFP) Risk Adjustment Operations
- Ensure delivery of accurate data and attainment of strategic objectives for risk adjustment
- Ensure compliance with coding guidelines, federal and state regulations, and quality standards
- Oversee external coding partners to meet accuracy standards and compliant application of coding rules
- Develop and deliver coding education to address gaps or deficiencies
- Participate in Risk Adjustment activities and projects and lead coding strategy and process improvement efforts
- Own, develop, and implement coding projects supporting data submissions to government oversight agencies and internal & RADV audits
- Lead cross-functional coding initiatives, liaise with matrix teams, and cultivate business partnerships
- Coach, train, and hold team accountable for adherence to coding guidelines and HHS risk adjustment rules
- Determine, monitor, and manage coding performance metrics; ensure 95%+ accuracy and compliant external partner performance
- Manage KPIs, report trends and challenges to leadership, and recommend optimizations in technologies, programs, processes, and people
- Serve as Subject Matter Expert for projects, lead platform implementations, and translate complex coding concepts into actionable guidance
- Resolve complex coding and data challenges using independent judgment and drive removal of roadblocks
Requirements
- High School diploma required; Bachelor’s degree or higher preferred
- 5+ years minimum coding experience required
- Certification by AHIMA or AAPC in one of: CPC, CCS-P, CCS-H, RHIT, RHIA
- Certified Risk Adjustment Coder (CRC) certification preferred
- Supervisory or management experience required
- Knowledge of CMS RADV audits; 2+ years RADV coding experience preferred
- Familiarity with HHS (PPACA) Risk Adjustment highly preferred
- Proficiency with CMS/HHS regulations and policies related to documentation and coding (Inpatient and Outpatient)
- HCC coding experience and Risk Adjustment knowledge strongly preferred
- Strong interpersonal, presentation, and communication skills (written and verbal)
- Strong analytical and organizational skills; detail-oriented
- Problem-solving skills and ability to identify coding issues and develop solutions
- Ability to provide clear guidance through change and in ambiguity
- Ability to work independently and collaboratively; relationship management skills
- Proficiency in Microsoft Excel, PowerPoint, Word, and Adobe Acrobat
- If working at home, internet via cable broadband or fiber optic with at least 10Mbps download/5Mbps upload
