CareOregon

Making health care work for everyone.

Senior Risk Adjustment Coding Auditor

AuditorAuditorFull TimeRemoteTeam 501-1,000Since 1994Company SiteLinkedIn

Location

Idaho + 4 moreAll locations: Idaho, Oregon, Texas, Utah, Wisconsin

Posted

12 days ago

Salary

$81K - $99K / year

Professional Certificate5 yrs expEnglish

Job Description

• Perform and lead a variety of coding-related audits for providers and other entities • Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data • Communicate audit results and recommendations for improvement to providers when needed • Create and maintain processes for tracking audit results and outcomes of reviews • Identify, track, analyze and report on any trends revealed in audits • Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders • Lead the development of educational materials and process documentation in a variety of mediums • Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations • Maintain active coding certification • Seek out emerging coding best practices • Serve as subject matter expert regarding correct coding practices • Collaborate with Risk Adjustment team to create SOPs and contribute to roadmaps for Risk Adjustment Coding initiatives • Onboard and train new Coding Auditors

Job Requirements

  • Minimum 5 years’ experience as a certified coder
  • Current coding certification from AHIMA or AAPC
  • One-year experience with risk adjustment program in a Health Plan
  • Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO) preferred
  • Experience leading group educational presentations and teaching to medical professionals
  • 5 years’ experience with CMS, HHS and/or CDPS+RX Hierarchical Condition Categories (HCC) models
  • Experience with or knowledge of risk adjustment principles

Benefits

  • Health insurance
  • Dental coverage
  • Vision insurance
  • Life insurance
  • AD&D insurance
  • Disability insurance
  • Health savings account
  • Flexible spending account(s)
  • Lifestyle spending account
  • Employee assistance program
  • Wellness program
  • Discounts and supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
  • Retirement plan with employer contributions
  • Paid time off (PTO) and Paid State Sick Time based on hours worked
  • Paid holidays, volunteer time, jury duty, and bereavement leave

Related Categories

Related Job Pages

More Auditor Jobs

Full TimeRemoteTeam 5,001-10,000

The Case Manager/Health Coach coordinates appropriate care, resources, and services for selected member populations, promoting effective utilization of health care resources to drive quality care. This involves serving on multidisciplinary teams, performing comprehensive assessments, and developing member-centric plans tailored to individual needs and barriers.

United States
$73.7K - $117K / year
Full TimeRemoteTeam 5,001-10,000

The Case Manager coordinates appropriate care, resources, and services for D-SNP member populations, promoting effective utilization of healthcare resources to drive quality care. This involves performing comprehensive assessments, developing member-centric plans, and performing ongoing monitoring and management of member progress.

United States
$73.7K - $117K / year

Risk Adjustment Auditor

Franciscan Health

Hospitals and healthcare services in Indianapolis, Lafayette, northwest and western Indiana and south-suburban Chicago.

Auditor12 days ago
Full TimeRemoteTeam 10,001+Since 1875H1B Sponsor

Risk Adjustment Auditor reviewing medical records and coding at Franciscan Health

United States
$19 - $28 / hour
Auditor12 days ago
Full TimeRemote

Valley View Hospital is seeking a qualified individual to work as a full-time Billing Auditor in our Patient Financial Services department. This is a REMOTE position! Must live in the United States. Billing or Insurance Follow-up experience required! Meditech/Epic experience pref...

United States
$20 - $29 / hour