[Hiring] Risk Adjustment Auditor @Martin’s Point Health Care

Role Description

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 the use of accurate medical coding of all professional, inpatient, and outpatient services, procedures, diagnoses, and conditions in support of a 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.

Qualifications

• Associates degree or combination of relevant education and experience
• 5+ years clinical coding experience, as well as experience in risk adjustment coding experience

Requirements

• 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 protocols, 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

• Comprehensive benefits package including medical, dental, and vision.
• Retirement savings with employer contributions.
• Paid time off (including volunteer time off!).
• Additional employee benefits such as pie day and more.