Quality Review and Audit Analyst

Pyramid Consulting, Inc; United States; Sur place; USD 35 817 - 39 261; Temps partiel

Avantages offerts par ce poste

Health insurance

401(k) plan

Paid sick leave

Résumé du poste

Pyramid Consulting, Inc. has an immediate need for a talented Quality Review and Audit Analyst for a 03+ months contract position with long-term potential, located remotely in the U.S.

Key responsibilities include conducting medical records reviews and performing audits to identify compliance risks. The ideal candidate has a high school diploma and at least 2 years' experience with relevant coding certifications, alongside a detail-oriented mindset.

Employee benefits include health insurance and a 401(k) plan.

Qualifications

• At least 2 years of experience with the following certifications: CPC, CCS-P, CCS-H, or RHIA.
• Experience with medical documentation audits and chart reviews.
• Familiarity with CMS regulations for Risk Adjustment.

Responsabilités

• Conduct medical records reviews with accurate diagnosis code abstraction.
• Perform documentation and data audits for compliance risks.
• Collaborate with team members on coding education.

Connaissances

ICD-10-CM coding guidelines

Risk Adjustment programs familiarity

Detail-oriented

Self-motivated

Excellent organizational skills

Communication skills

Formation

High school diploma

Outils

Excel

MS Word

Adobe Acrobat

Description du poste

Immediate need for a talented Quality Review and Audit Analyst. This is a 03+ months contract opportunity with long-term potential and is located in U.S. (Remote).

Job ID: 26-12948

Pay Range: $26/hr - $28.50/hr. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Client IFP Coding Guidelines and Best Practices, HHS Protocols and any additional 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 data capture, through the lens of HHS’ Risk Adjustment.
• Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment 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 submission program. Inclusive of Quality Audits for vendor coding partners.
• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners.
• Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or 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, including contributing to Client IFP Coding Guideline updates and policy determinations, as needed.

Key Requirements and Technology Experience:

• The Quality Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC):
• Certified Professional Coder (CPC)
• Certified Coding Specialist for Providers (CCS-P)
• Certified Coding Specialist for Hospitals (CCS-H)
• Registered Health Information Administrator (RHIA)
• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding 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

Our client is a leading Health Insurance Industry.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.