Risk Adjustment Auditor II

Cambia Health Solutions • Portland, OR

2d • Hybrid

About The Position

Risk Adjustment Auditor II Work a Hybrid schedule within Oregon, Idaho, Utah or Washington Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of Risk Adjustment Auditors is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Auditors perform Retrospective/Prospective chart reviews both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting. They also Identify trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies – all in service of making our members’ health journeys easier . Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. What You Bring to Cambia: Qualifications: Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience.

Requirements

• Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience.
• Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required.
• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
• Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.
• Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
• Demonstrated ability to identify and communicate trends in provider coding and documentation.
• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
• Effective verbal and written communication skills.
• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
• Demonstrated ability to provide proactive and creative solutions to business problems.

Nice To Haves

• RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.

Responsibilities

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
• Supports and actively participates in process and quality improvement initiatives.
• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
• Consistently meets departmental performance and attendance requirements.
• Serves as a mentor to Risk Adjustment Auditor I staff.
• Assists with special projects such as risk mitigation reviews.
• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
• Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program.
• Assists with implementation activities as a result of regulatory changes to the Program.

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees