Remote Risk Adjustment QA & Auditing Supervisor

Excellus Health Plan Inc.; City of Rochester (NY); Hybrid; USD 72,000 - 129,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus Health Plan Inc. in New York seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing, to oversee the daily operations of the QA Auditor team and ensure accuracy and compliance with CMS ICD-10-CM and HCC coding standards.

You will lead training, performance management, and drive improvements across risk adjustment audits including IPM, RADV, HRADV. You will partner with leadership to prioritize audits, set expectations, monitor quality and turnaround times, and develop

Qualifications

• Five (5) years ICD-10-CM and HCC coding experience required and experience in CMS and HHS RADV/HRADV audits.
• Prior experience supervising or managing people and/or projects.
• Associate's degree in a health care related field preferred.
• CPC and CRC certifications required.
• Advanced knowledge of medical terminology, anatomy and physiology.
• Knowledge of CMS and HHS HCC Risk Adjustment coding practices.

Responsibilities

• Provide strategic oversight and supervision to the Risk Adjustment QA Auditor team in accordance with standards.
• Direct daily operations of the QA Audit team to ensure coding accuracy and regulatory compliance.
• Oversee RADV/HRADV audits and related CMS/HHS audits and deadlines.
• Document audit expectations and project parameters for staff.
• Coach and train staff; conduct performance evaluations and feedback sessions.
• Ensure audits comply with CMS guidelines and ICD-10-CM Official Coding Guidelines.

Skills

ICD-10-CM coding

HCC coding

CMS RADV audits

Team leadership

Communication skills

Education

CPC certification

CRC certification

CDEO certification

Tools

EMR systems

Job description

Excellus Health Plan Inc. in New York seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing, to oversee the daily operations of the QA Auditor team and ensure accuracy and compliance with CMS ICD-10-CM and HCC coding standards.

You will lead training, performance management, and drive improvements across risk adjustment audits including IPM, RADV, HRADV. You will partner with leadership to prioritize audits, set expectations, monitor quality and turnaround times, and develop