Auditor, Risk Adjustment (Remote)

Molina Healthcare; Scottsdale (AZ); Remote; USD 77,000 - 129,000; Full time

Job summary

A healthcare organization is seeking a Risk Adjustment Data Validation specialist to assist with daily operations, support audit projects, and ensure compliance with CMS standards. Candidates should have at least 3 years of experience in coding and hold an active coding certification. Competitive benefits and compensation are offered.

Benefits

Competitive benefits and compensation

Equal Opportunity Employer

Qualifications

• At least 3 years in coding, medical record review, and risk adjustment data validation.
• Active and unrestricted Coding Certification (CCS, CCS-P, or CPC).

Responsibilities

• Assist in the daily operations of risk adjustment data validation activities.
• Support risk adjustment audit projects to meet goals and objectives.
• Evaluate audit results to identify barriers, gaps, and improvement opportunities.

Skills

Risk adjustment data validation

Audit project management

Data analysis

Medical coding

Compliance with CMS

Education

Associate's degree

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

Tools

Data software tools

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. Ensures that the provider organization is adequately protected against financial loss through proper combination of casualty and liability insurance.

Knowledge/Skills/Abilities

• Assist in the daily operations of all aspects of risk adjustment data validation activities, including progress tracking, chart retrieval, file transmissions, and adherence to timelines.
• Support risk adjustment audit projects to meet goals, objectives, milestones, and deliverables.
• Evaluate audit results to identify barriers, gaps, opportunities for improvement, and implement corrective actions.
• Act as an audit liaison with departments, health plans, and external vendors.
• Develop and implement processes to ensure accuracy, completeness, and CMS compliance of risk adjustment data.
• Oversee RAPS and EDPS data transmission, identifying issues affecting data integrity and accuracy.
• Identify opportunities for data mining to minimize data gaps.
• Apply best practices to ensure accurate risk adjustment payments across markets.
• Perform monthly audits on internal Molina Coding Specialists and external vendors.

Job Qualifications

Required Education

Associate's degree.

Required Experience

At least 3 years in coding, medical record review, and risk adjustment data validation.

Required License, Certification, Association

Active and unrestricted Coding Certification (CCS, CCS-P, or CPC).

Preferred Education

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

Note: Current Molina employees interested in this position should apply through the intranet job listing.

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

Pay Range: $77,969 - $128,519 annually.

*Actual compensation may vary based on location, experience, education, and skills.