Risk Adjustment Auditor

Responsibilities: - Responsible for daily operations pertaining to Risk Adjustment including medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts. - Mitigate risk by validating Encounter Data Gathering Environment Server (EDGE) data is supported within provider encounter documentation. - Review the performance of the Risk Adjustment Coding team and report audit trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented. - Maintain compliance with national standards and coding practices set by the ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards. - Conduct CMS audits of Risk Adjustment activities, including but not limited to Risk Adjustment Data Validation audits. - Develop relationships with key individuals to foster an increased understanding of the Risk Adjustment process. - Identify and execute on the creation of clinical document improvement resources for provider education in both MA and ACA line of business. - Manage the implementation process improvements that will maximize risk adjustment factor increases. - Compliance with all applicable laws and regulations. - Other duties as assigned. Requirements: - Bachelor's degree in a relevant field of study or commensurate work experience. - Certified professional coder (CPC). - 3+ year(s) retrospective risk adjustment coding experience. - 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience. Bonus points: - Certified Risk Adjustment Coder (CRC) or similar certification. - Experience coding in a variety of different Electronic Medical Record (EMR) systems.