Auditor, Risk Adjustment (Remote)

Molina Healthcare; Buffalo (NY); Remote; USD 77,000 - 129,000; Full time

Job summary

A healthcare organization in Buffalo, NY, is seeking a skilled professional to manage risk adjustment data validation and coding audits. The ideal candidate will have at least 3 years of relevant experience and an active coding certification. Responsibilities include developing processes for accuracy and compliance with CMS regulations, and supporting audit projects. Competitive compensation package offered.

Benefits

Competitive benefits package

Qualifications

• Minimum 3 years in coding and medical chart review with experience in data validation.
• Active and unrestricted Coding Certification (CCS, CCS-P, CPC).

Responsibilities

• Assist in daily operations related to risk adjustment activities.
• Support risk adjustment audit projects to meet objectives.
• Develop processes for compliance with CMS regulations.

Skills

Risk adjustment data validation

Audit liaison

Data integrity and accuracy

Data mining

Education

Associate's degree

Bachelor's Degree in Business Administration or Healthcare Management

Job description

Job Description

Job Summary

Develops, recommends, and implements controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.

Knowledge/Skills/Abilities

• Assist in the daily operations of all aspects of risk adjustment data validation related activities, including progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines.
• Support all risk adjustment audit-related projects to ensure goals, objectives, milestones, and deliverables are met.
• Evaluate results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans as necessary.
• Act as an audit liaison with other departments, health plans, and external vendors.
• Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data.
• Understand and oversee RAPS and EDPS data transmission and assist in identifying issues that impact data integrity and accuracy.
• Identify opportunities for data mining to ensure data gaps are minimized.
• Apply best practices to ensure accuracy of risk adjustment payments in all markets.
• Perform monthly audits on internal Molina Coding Specialists.
• Audit external Molina Vendors.

Job Qualifications

Required Education

Associate's degree.

Required Experience

3 years in coding and medical record chart review, with experience in risk adjustment data validation.

Required License, Certification, Association

Active and unrestricted Coding Certification, such as CCS, CCS-P, or CPC credential.

Preferred Education

Bachelor's Degree in Business Administration, Healthcare Management, or related field.

To all current Molina employees: If interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 / ANNUAL

*Actual compensation may vary based on geographic location, work experience, education, and/or skill level.