Risk Adjustment Auditor
New
O
OscarHealth insurance
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas.Full-TimeJunior
Salary82,717 - 108,566 USD per year
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Job Details
- Experience
- 3+ year(s) retrospective risk adjustment coding experience. 1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience
Requirements
- Bachelor's degree in a relevant field of study or commensurate work experience.
- Certified Professional Coder (CPC).
- 3+ years of retrospective risk adjustment coding experience.
- 1+ year of quality auditing and/or Risk Adjustment Data Validation Audit (RADV) experience.
- Certified Risk Adjustment Coder (CRC) or similar certification is a bonus.
- Experience coding in a variety of Electronic Medical Record (EMR) systems is a bonus.
Responsibilities
- Review medical records and report ICD-10-CM diagnosis codes for ACA and MA lines of business.
- Support potential CMS and HHS audits and medical record retrieval efforts.
- Validate that Encounter Data Gathering Environment Server (EDGE) data is supported by provider encounter documentation.
- Review Risk Adjustment Coding team performance and report audit trends to leadership.
- Maintain compliance with ICD-10-CM coding guidelines and Risk Adjustment production standards.
- Conduct CMS audits of Risk Adjustment activities, including Risk Adjustment Data Validation audits.
- Develop relationships with key individuals to increase understanding of the Risk Adjustment process.
- Create clinical documentation improvement resources for provider education in MA and ACA lines of business.
- Manage implementation of process improvements to maximize risk adjustment factor increases.
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