Risk Adjustment Auditor

New

Skills

Benchmarking CMS RADV audits Compliance management Data analysis Healthcare regulations ICD-10 coding Project management Provider education Quality auditing Risk adjustment coding

The Auditor for Risk Adjustment will play a crucial role in ensuring the accuracy and compliance of ICD-10 code abstraction through both internal and external quality audits. This position requires a detail-oriented professional to benchmark quality assurance thresholds, report trends to leadership, and drive continuous improvements within the organization. The role also involves conducting CMS RADV audits and developing educational resources for providers.

Key Responsibilities
  • Conduct internal and external quality audits for ICD-10 code abstraction.
  • Benchmark QA thresholds and programs with management.
  • Report audit trends to leadership and drive improvements.
  • Maintain compliance with ICD-10-CM coding guidelines.
  • Conduct CMS RADV audits of risk adjustment activities.
  • Develop provider education resources for MA and ACA.
Required Skills & Qualifications
  • Bachelor's degree in a relevant field or commensurate work experience.
  • Certified Professional Coder (CPC).
  • 3+ years of retrospective risk adjustment coding experience.
  • 1+ year in Quality Auditing and/or RADV.

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Job Type: Remote

Salary: Not Disclosed

Experience: Entry

Duration: Months

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