Remote Risk Adjustment Auditor & Coding Educator

Tufts Medicine; Northern (KY); Hybrid; USD 72,000 - 90,000; Full time

Job summary

Tufts Medicine Integrated Network is seeking a Risk Adjustment Consultant to perform accurate reviews of Medicare, Medicaid, and Commercial HCCs through chart audits. You will validate ICD-10-CM and CPT coding for CMS and commercial guidelines, summarize findings for leadership, and educate physicians on coding requirements.

Remote (MA-based) position focusing on risk adjustment coding practices. The role emphasizes auditing proficiency, regulatory knowledge, and collaboration with risk

Qualifications

• CRC certification is required or must be obtained within 12 months of employment.
• Two years of outpatient billing, coding, and risk adjustment experience.
• Associate degree preferred; CRC highly preferred.
• Two years of outpatient billing, coding, risk adjustment and primary care adult medicine experience.

Responsibilities

• Perform ongoing audits of medical records for accuracy in diagnosis and CPT coding.
• Audit medical records for CMS and DxCG guideline compliance.
• Evaluate provider records for valid signatures and CPT codes.
• Summarize audit findings for leadership and track trends over time.
• Collaborate with staff and vendors to identify coding adjustments.
• Educate physicians on Risk Adjustment Coding guidelines and ICD-10-CM rules.
• Maintain up-to-date knowledge of coding rules and CMS guidelines.
• Interpret and summarize CMS regulations for leadership.
• Incorporate guideline changes into audit practice and resolve regulatory issues.
• Conduct pre-visit chart reviews and provider outreach as needed.
• Provide coding expertise to evaluate internal coding program opportunities.
• Deliver LCO and network provider trainings and education.
• Summarize recommendations to internal staff and leadership.
• Identify coding issues and propose courses of action.

Skills

Audit medical records

Risk adjustment coding

CMS guidelines

Education outreach

Education

CRC Certification

Associate degree

Job description

Tufts Medicine Integrated Network is seeking a Risk Adjustment Consultant to perform accurate reviews of Medicare, Medicaid, and Commercial HCCs through chart audits. You will validate ICD-10-CM and CPT coding for CMS and commercial guidelines, summarize findings for leadership, and educate physicians on coding requirements.

Remote (MA-based) position focusing on risk adjustment coding practices. The role emphasizes auditing proficiency, regulatory knowledge, and collaboration with risk