Risk Adjustment Auditor

Martin's Point Health Care • Portland, ME

2d

About The Position

The Risk Adjustment Auditor is responsible for the ongoing monitoring, quality assurance, auditing and validating coding and documentation for the risk adjustment. The Auditor is responsible for auditing medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses, and conditions in support of compliant risk adjustment program. This work is performed utilizing the Official ICD Guidelines for Coding and Reporting, MPHC Internal Guidelines, AHA Coding Clinics, CMS RADV Auditor Guide, and all other MPHC organization guidelines, policies, and procedures.

Requirements

• Associates degree or combination of relevant education and experience
• 5+ years clinical coding experience, as well as experience in risk adjustment coding experience
• Certified Coder (CPC/COC) or Certified Risk Coder (CRC) required with other coding certifications considered on a case-by-case basis
• Proficient understanding of ICD9/10 CM, CPT, and other specialty system coding guidelines as required by diagnostic category
• Strong knowledge of medical terminology and chronic disease management
• Strong auditing skills, specific to Medicare Risk Adjustment
• Excellent written and verbal communication skills
• Strong problem-solving skills
• Strong organizational skills
• Ability to relate to different types of people and build constructive and effective relationships
• Ability to work independently with minimal supervision

Responsibilities

• Conducts coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes to ensure compliance.
• Reviews patient medical records, including physician notes, lab results, and diagnostic reports, to identify relevant diagnoses and capture essential information for accurate coding.
• Assigns appropriate ICD-10 codes to document and accurately represent the patient’s conditions and ensure compliance with coding guidelines and regulations.
• Stays updated with changes in HIPAA protocol’s, coding guidelines, regulations, and compliance standards to maintain accuracy and compliance within the coding process.
• Meets team performance metrics for both quantity of work completed and quality audit scores.
• Conducts RADV/IPM Chart Review duties as assigned.
• Periodically participates in Coding Advisory Committee.

Benefits

• medical
• dental
• vision
• retirement savings with employer contributions
• paid time off
• volunteer time off
• pie day

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree