Remote Medical Coding Auditor: HCC/RADV Specialist

BigR.io; United States; Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Two monitors

Laptop

Keyboard

Mouse

Headset

Job summary

BigR.io seeks a Medical Coding Auditor to review inpatient and outpatient records for HCCs, ensuring documentation supports codes under CMS RADV/HHS RADV guidelines. Work is remote in the United States with a 7-4 or 8-5 local schedule Monday–Friday.

Must hold CRC certification and have 5+ years of risk adjustment auditing, especially CMS/HHS RADV experience. Proficiency in ICD-10 guidelines, AHA Coding Clinic, and strong Excel skills are required; prior vendor coding review and familiarity with

Qualifications

• Experience with CMS RADV and HHS RADV audits.
• Vendor coding review experience.
• Ability to meet chart review production requirements.
• Experience in risk adjustment auditing.
• CRC certification through AAPC or AHIMA.
• 5+ years in risk adjustment auditing focusing on CMS/HHS RADV.

Responsibilities

• Reviews and researches billed unlisted procedure codes to determine if a more specific code exists.
• Supplies cover and pricing information to client Medical Director regarding unlisted codes.
• Conducts meetings with state client to discuss procedure code coverage and ensures coding decisions are implemented.
• Responsible for archiving all Procedure Code Workgroup (PCW) agendas, minutes, and related materials.
• Maintains HIPAA reason and remark code lists and provides code updates to the HIPAA Code Workgroup, when necessary.
• Supports the Claims Department by working edit reports as assigned.
• Provides Provider Relations with coding issues and updates to be shared with providers to ensure timely and accurate claim payment.
• Maintains a library of code books and relevant resources to be available to personnel, when necessary.
• Serves as a resource for the client and coworkers with questions related to coding issues.

Skills

CMS RADV & HHS RADV audits

Vendor coding review experience

Chart review production requirements

Risk adjustment auditing

CRC certification

5+ years RADV auditing

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Excel

Job description

BigR.io seeks a Medical Coding Auditor to review inpatient and outpatient records for HCCs, ensuring documentation supports codes under CMS RADV/HHS RADV guidelines. Work is remote in the United States with a 7-4 or 8-5 local schedule Monday–Friday.

Must hold CRC certification and have 5+ years of risk adjustment auditing, especially CMS/HHS RADV experience. Proficiency in ICD-10 guidelines, AHA Coding Clinic, and strong Excel skills are required; prior vendor coding review and familiarity with