Risk Adjustment Audit Reviewer

Apex Systems; Phoenix (AZ); Remote; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, vision, life, and DIS

401K with company match

HSA option

Employee Assistance Program (EAP)

Certification discounts and courses

Career coaching and consultant support

Job summary

Everforth Apex Systems is seeking a Risk Adjustment Audit Reviewer in Phoenix (Remote) to serve as a coding compliance resource for Risk Adjustment initiatives. You will review audit findings, educate on opportunities, and support CMS audits with documentation.

The role requires deep ICD-10 coding knowledge, CMS Risk Adjustment guidelines, and CPC or AHIMA certification, with emphasis on communicating findings to leadership and internal staff.

Qualifications

• Bachelor's degree in healthcare administration or related field, or equivalent experience.
• Four years of coding or audit experience, including two years in Risk Adjustment Coding.
• Knowledge of outpatient and inpatient guidelines.
• Deep understanding of ICD-10 Coding Guidelines, CMS Risk Adjustment guidelines, Anatomy/Physiology, the disease process, and medical terminology.
• Certified Professional Coder (CPC) OR AHIMA certification is required.

Responsibilities

• Review audit findings and educate on identified opportunities.
• Communicate effectively with leaders, peers, and vendors.
• Utilize deep knowledge of ICD-10 coding and risk adjustment guidelines.
• Immediately report adverse audit trends and potential risk areas to leadership.
• Provide education to internal staff based on audit findings.
• Effectively communicate the audit process and results to leaders.
• Audit all vendor risk adjustment activity.
• Adhere to stringent timelines consistent with project deadlines.

Skills

ICD-10 guidelines

CMS Risk Adjustment guidelines

Anatomy/Physiology

Disease process

Medical terminology

Organizational skills

Interpersonal skills

CPC certification

AHIMA certification

Education

Bachelor's degree in healthcare administration

Job description

Job#: 3052972

Job Description:

Risk Adjustment Audit Reviewer

Location:

Phoenix, Arizona (Remote)

Alternate Location:

California, Colorado, Nevada, Nebraska, Wyoming

Role Overview

This position will serve as a coding compliance resource for Risk Adjustment initiatives. The role involves reviewing audit findings, providing education on identified opportunities, and offering objective supporting documentation to support findings. The focus is on compliance with CMS regulations, Medicare Advantage, and coding standards, including auditing internal coders and preparing for CMS audits.

Key Responsibilities

• Review audit findings and provide education on identified opportunities.
• Communicate effectively with leaders, peers, and vendors.
• Utilize deep knowledge of ICD-10-CM coding and risk adjustment guidelines.
• Immediately report adverse audit trends and potential areas of risk to leadership.
• Provide education to internal staff based on audit findings.
• Effectively communicate the audit process and results to appropriate leaders.
• Audit all vendor risk adjustment activity.
• Adhere to stringent timelines consistent with project deadlines.

Required Qualifications

Education: Must possess current knowledge of Healthcare/Coding as normally obtained through the completion of a bachelor’s degree in healthcare administration or related field, or equivalent experience in a related field.

Experience: Four years of coding or audit experience, including two years of Risk Adjustment Coding. Knowledge of outpatient and inpatient guidelines is required.

Skills: Deep understanding of ICD-10 Coding Guidelines, CMS Risk Adjustment guidelines, Anatomy/Physiology, the disease process, and medical terminology. Strong organizational and interpersonal skills, including the ability to deliver difficult information positively. Certified Professional Coder (CPC) OR American Health Information Management Association (AHIMA) certification is required.

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC) certification.
• Previous risk adjustment auditing experience and/or experience with provider education.
• Experience with health plans is helpful.

Everforth Apex Benefits Overview

• Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection.
• We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure.
• Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts.
• In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA.
• Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or 804-523-8228. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

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Everforth Apex Systems is part of the Commercial Segment of Everforth, Inc.

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