Risk Adjustment Auditor II — Hybrid/Remote Mentor

Cambia Health Solutions; Boise (ID); Hybrid; USD 58,000 - 94,000; Full time

Job summary

Cambia Health Solutions is seeking a Risk Adjustment Auditor I or II to perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. You will conduct quality reviews of vendor coding and verify the accuracy of diagnosis codes based on chart documentation.

The role requires an associate degree in healthcare or related field with experience in clinical coding or auditing; different levels require 1–3 years of experience.

Qualifications

• Risk Adjustment Auditor I would have an Associate degree in Healthcare or related field and one year of experience in clinical coding or auditing or equivalent combination of education and experience.
• Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience.
• Risk Adjustment, HCC or Inpatient coding experience required.

Responsibilities

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
• Performs quality reviews of vendor coding in support of the risk adjustment process.
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC and HHS HCC categories.
• Identifies trends in provider and vendor coding and documentation and partners with coding team manager and training lead to develop intervention strategies.
• Supports and actively participates in process and quality improvement initiatives.
• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
• Consistently meets departmental performance and attendance requirements.
• Serves as a mentor to Risk Adjustment Auditor I staff.
• Assists with special projects such as risk mitigation reviews.
• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
• Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program.

Skills

Risk Adjustment coding

CPC and CRC certification

Analytical skills

Verbal and written communication

Microsoft Office proficiency

Education

Associate degree in Healthcare or related field

Tools

ICD-9-CM/ICD-10 Guidelines

Job description

Cambia Health Solutions is seeking a Risk Adjustment Auditor I or II to perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting. You will conduct quality reviews of vendor coding and verify the accuracy of diagnosis codes based on chart documentation.

The role requires an associate degree in healthcare or related field with experience in clinical coding or auditing; different levels require 1–3 years of experience.