Lead Risk Adjustment QA & Auditing

Excellus BCBS; City of Rochester (NY); À distance; USD 72 000 - 129 000; Plein temps

Avantages offerts par ce poste

Remote work option

Résumé du poste

Excellus BCBS seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing to lead the QA Auditor team, ensuring accuracy, compliance with CMS ICD-10-CM guidelines, and timely audits. This role provides coaching, training, and performance management while driving process improvements.

You will supervise daily QA activities, ensure coding accuracy, and oversee RADV and HRADV audits, partnering with leadership to enhance efficiency and maintain member privacy.

Qualifications

• Five years ICD-10-CM and HCC coding experience required.
• Experience supervising or managing people and/or projects.
• CPC and CRC certifications required; other current coding certifications preferred.

Responsabilités

• Provide strategic oversight to a QA audit team ensuring compliance with standards.
• Direct day-to-day operations of the QA auditors and ensure coding accuracy.
• Oversee RADV audits and ensure timely, accurate audit delivery.
• Develop training materials and conduct staff coaching and performance reviews.
• Maintain privacy and integrity in handling member information.

Connaissances

ICD-10-CM coding

HCC coding experience

CMS RADV auditing

HHS RADV auditing

Coaching and training

Formation

Associate's degree in health care related field

Outils

EMR systems

ICD-10-CM guidelines

Description du poste

Excellus BCBS seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing to lead the QA Auditor team, ensuring accuracy, compliance with CMS ICD-10-CM guidelines, and timely audits. This role provides coaching, training, and performance management while driving process improvements.

You will supervise daily QA activities, ensure coding accuracy, and oversee RADV and HRADV audits, partnering with leadership to enhance efficiency and maintain member privacy.