Risk Adjustment Auditor: Drive Accurate Coding & Compliance

Martin's Point Health Care Inc.; New York (NY); Remote; USD 76,000 - 93,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Retirement savings

Job summary

Martin's Point Health Care in Maine and beyond seeks a dedicated Risk Adjustment Auditor to monitor and validate coding and documentation for risk adjustment programs. You will audit medical records, assign ICD-10 codes, and ensure compliance with ICD guidelines, HIPAA, and CMS RADV standards.

Qualified candidates have an associate's degree (or equivalent) with 5+ years of clinical coding and risk adjustment experience, CPC/COC or CRC certification, strong communication, and the ability to work

Qualifications

• Associate's degree or equivalent with 5+ years of clinical coding experience.
• Experience in risk adjustment coding required.
• Certified coder (CPC/COC) or CRC certification preferred.

Responsibilities

• Audit medical records for risk adjustment to ensure compliant coding.
• Review physician notes, labs, and reports to identify diagnoses.
• Assign ICD-10 codes accurately per guidelines.
• Stay updated on HIPAA, coding guidelines and regulations.
• Meet team performance metrics for quantity and quality.
• Perform RADV/IPM Chart Review as assigned.
• Participate in Coding Advisory Committee.

Skills

ICD-10 Coding

Auditing

Medical terminology

Documentation review

HIPAA compliance

Communication

Independent work

Organizational skills

Education

Associate's degree

CPC/COC or CRC certification

Tools

AHA Coding Clinics

CMS RADV Guide

Job description

Martin's Point Health Care in Maine and beyond seeks a dedicated Risk Adjustment Auditor to monitor and validate coding and documentation for risk adjustment programs. You will audit medical records, assign ICD-10 codes, and ensure compliance with ICD guidelines, HIPAA, and CMS RADV standards.

Qualified candidates have an associate's degree (or equivalent) with 5+ years of clinical coding and risk adjustment experience, CPC/COC or CRC certification, strong communication, and the ability to work