Quality Review and Audit Analyst

HireTalent; Franklin (TN); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading company in healthcare is seeking remote candidates for a medical coding role focusing on HCC/Risk Adjustment. Candidates will conduct medical records reviews, support compliance audits, and collaborate with partners for effective coding practices. Ideal candidates have strong communication skills and extensive coding knowledge.

Qualifications

• 2+ years of HCC/Risk Adjustment experience required.
• Excellent organization skills and detail-oriented.
• Experience working in a remote environment.

Responsibilities

• Conduct medical records reviews and accurate diagnosis code abstraction.
• Perform audits identifying gaps and compliance risks.
• Coordinate with team members to facilitate coding education.

Skills

HCC/Risk Adjustment experience

Microsoft Office Experience

Excellent Written and Verbal communication skills

ICD-10-CM coding guidelines and conventions

Understanding of medical claims submissions

Computer competency

Tools

Microsoft Word

Adobe Acrobat

Excel

Job description

This position is 100% remote and candidates can be sourced from across the US as long as they're able to support the EST schedule.
Please list the candidate's location clearly on their resume.
Candidates must have a quiet and private working environment.
Candidates must have a reliable, high-speed internet connection.
Candidates cannot have any pre-planned/scheduled time off during the first 30 days of assignment.
Conduct medical records reviews with accurate diagnosis code abstraction in accordance with OfficialCoding Guidelines and Conventions, *** IFP Coding Guidelines and Best Practices, HHS Protocols and anyadditional applicable rule set.
Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for datacapture, through the lens of HHS’ Risk Adjustment.
Perform various documentation and data audits with identification of gaps and/or inaccuracies in riskadjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs,including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submissionprogram. Inclusive of Quality Audits for vendor coding partners.
Collaborate and coordinate with team members and matrix partners to facilitate various aspects of codingand Risk Adjustment education with internal and external partners.
Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risksor program gaps to management in a timely manner.
Communicate effectively across all audiences (verbal & written).
Develop and implement internal program processes ensuring CMS/HHS compliant programs, includingcontributing to *** IFP Coding Guideline updates and policy determinations, as needed.

TOP 3 NON-NEGOTIABLE SKILLS (OUTSIDE OF CERTIFICATION)
- HCC/Risk Adjustment experience (2 years+)
- Microsoft Office Experience
- Excellent Written and Verbal communication skills
Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CMcoding guidelines and conventions
Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation andcoding compliance, with both Inpatient and Outpatient documentation
HCC coding experience preferred
Computer competency with excel, MS Word, Adobe Acrobat
Must be detail oriented, self-motivated, and have excellent organization skills
Understanding of medical claims submissions is preferred
Ability to meet timeline, productivity, and accuracy standards
Experience working in a remote environment
Excellent and clear written and verbal communication skills