ICD-10 Data Integrity & Risk Adjustment Auditor

ConcertoCare; United States; On-site; USD 65,000 - 75,000; Full time

Benefits offered by this job

Full healthcare coverage

401K with match

Annual bonus

Job summary

ConcertoCare is seeking a Data Integrity Specialist (ICD-10) to review and ensure accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions. This role conducts pre-claim, concurrent, and retrospective audits and collaborates with CDI specialists to improve performance under value-based care contracts.

The ideal candidate brings advanced ICD-10-CM/CMS-HCC knowledge and at least 4 years of auditing experience with a CRC/CPC/CPC-H credential.

Qualifications

• Minimum 4 years experience in ICD-10 auditing.
• Certification CRC, CPC, or CPC-H required.
• HS diploma required; Bachelor's preferred.
• Advanced knowledge of ICD-9-CM, ICD-10-CM, CPT and HCPCS coding and regulatory requirements.
• Proficient in Microsoft Office and coding/compliance standards.
• Strong writing, grammar, and documentation skills.
• Ability to manage multiple priorities with integrity.

Responsibilities

• Review CMS Risk Adjustment methodology and documentation.
• Maintain daily production review with 95%-98% accuracy.
• Perform pre-claim audits and issue corrections for proper codes.
• Validate diagnoses are supported by clinical documentation and MEAT criteria.
• Identify and remediate unsupported or inaccurate conditions before claim submission.
• Complete retrospective audits to identify trends and improvement opportunities.
• Participate in concurrent and prospective reviews with CDI teams.
• Support audit readiness for internal, external, and plan audits.

Skills

ICD-10 Auditing

Analytical problem solving

Multitasking/Prioritization

Microsoft Office proficiency

Technical writing

Education

Bachelor's degree in Healthcare/Finance/Business

Coding certification: CRC/CPC/CPC-H

High school diploma

Tools

Microsoft Office Suite

Job description

ConcertoCare is seeking a Data Integrity Specialist (ICD-10) to review and ensure accuracy, completeness, and compliance of risk adjustment coding for internal claim submissions. This role conducts pre-claim, concurrent, and retrospective audits and collaborates with CDI specialists to improve performance under value-based care contracts.

The ideal candidate brings advanced ICD-10-CM/CMS-HCC knowledge and at least 4 years of auditing experience with a CRC/CPC/CPC-H credential.