Remote Risk-Adjustment Coding Auditor (HCC/Medicare)

Good Samaritan Society; South Dakota; Hybrid; USD 30,000 - 48,000; Full time

Job summary

Sanford Health, the largest rural health system in the United States, seeks a Coding Audit Specialist to ensure the accuracy of CMS/DHS risk adjustment data. You will audit medical records for correct coding (CPT, ICD-9/10, HCPCS) and develop monitoring programs across Medicare Advantage, ACA/Exchange, and BadgerCare Plus.

Requirements include a high school diploma, 3 years in health insurance or auditing, and CPC/CRCoder within one year.

Qualifications

• High school diploma or equivalent required with knowledge of anatomy/physiology.
• Coursework in CPT, ICD-9 and ICD-10 coding required.
• Three years of experience in health insurance, compliance, QA, or auditing.
• Certified Professional Coder and/or Certified Risk Adjustment Coder within 1 year of hire.
• Proficiency with Word, Excel, and Access.

Responsibilities

• Audit and ensure accuracy of CMS and DHS risk adjustment data.
• Audit medical records to determine correct diagnostic coding per CPT/ICD guidelines.
• Develop and monitor a continuous monitoring program for Medicare Advantage and ACA/BadgerCare.
• Prepare concise audit summaries presenting findings clearly.
• Maintain knowledge of CPT, ICD-9/10, HCPCS, and CMS guidelines.

Skills

Anatomy/physiology

Medical terminology

Word

Excel

Access

Education

High school diploma or equivalent

Associate degree in coding/health field

Tools

CPT coding

HCPCS coding

ICD-9/ICD-10 coding

Job description

Sanford Health, the largest rural health system in the United States, seeks a Coding Audit Specialist to ensure the accuracy of CMS/DHS risk adjustment data. You will audit medical records for correct coding (CPT, ICD-9/10, HCPCS) and develop monitoring programs across Medicare Advantage, ACA/Exchange, and BadgerCare Plus.

Requirements include a high school diploma, 3 years in health insurance or auditing, and CPC/CRCoder within one year.