Risk Adjustment Audit and Compliance Specialist

CommonSpirit Health; Bakersfield (CA); On-site; USD 60,000 - 100,000; Full time

Benefits offered by this job

Flexible Health & Welfare benefits

401k retirement plan with employer-match

Paid Time Off

Sick Leave

Job summary

An established industry player seeks a Risk Adjustment Audit and Compliance Specialist to enhance compliance and optimize risk adjustment processes. This pivotal role involves conducting audits, ensuring adherence to regulatory standards, and collaborating with various teams to support financial stability in value-based operations. The ideal candidate will possess a strong background in risk adjustment coding, compliance, and auditing, along with a Bachelor's degree and relevant certifications. Join a forward-thinking organization that prioritizes quality care and offers a comprehensive benefits package, including flexible health benefits and a generous retirement plan. If you are passionate about improving healthcare outcomes and compliance, this opportunity is perfect for you.

Qualifications

• 3-5 years of experience in risk adjustment coding and compliance.
• Certified Professional Coder (CPC) Certification required.

Responsibilities

• Conduct audits to measure operational risk and ensure compliance.
• Collaborate with teams to enhance the risk adjustment coding process.

Skills

Risk adjustment coding

Compliance auditing

ICD-10 coding

Provider education outreach

Microsoft Excel

Microsoft Word

Microsoft Outlook

Microsoft PowerPoint

Google applications

Education

Bachelor's degree in a related field

Tools

Microsoft Office

Job description

Overview

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans, and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options including medical, dental, and vision plans for the employee and their dependents, Health Spending Account (HSA), Life Insurance, and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

Responsibilities

***This position is remote.

Position Summary:

The Risk Adjustment Audit and Compliance Specialist conducts audits to measure operational risk, establishes processes to gather feedback from providers and inform and/or perform provider educational outreach, and ensures adherence to regulatory requirements. The Risk Adjustment Audit and Compliance Specialist will work closely with team members across the Quality and Risk Population Health Services Organization (PHSO) function, specifically the Value-based Coders and the Risk Adjustment Coding and Training Specialist, to ensure the risk adjustment coding process is accurate and compliant with national and local regulations. This role also collaborates with Value Hub Network Operations and Quality & Risk teams to inform local provider engagement and may require travel to provider locations. The role reports directly to the Risk Adjustment Population Health Director and plays a critical role in optimizing the overall risk adjustment process, enhancing compliance, and ensuring financial stability and profitability of the PHSO value-based operations and programs.

Qualifications

Minimum Qualifications:

- 3-5 years of experience with risk adjustment coding, compliance, and/or auditing

- Bachelor’s degree or equivalent experience in a related field

- Certified Professional Coder (CPC) Certification

- Strong understanding of ICD-10 coding and HCCs

- Experience working in a value-based care environment

- Extensive knowledge of Microsoft Office applications; Excel, Word, Outlook, PowerPoint, and Google applications

Preferred Qualifications:

- Certified Professional Medical Auditor (CPMA) certification preferred

- Experience in developing and delivering training programs in a healthcare setting preferred