Risk Adjustment Auditor - Remote

martin; Portland (ME); Remote; USD 76,000 - 93,000; Full time

Benefits offered by this job

Medical insurance

Paid time off

Job summary

Martin's Point Health Care is seeking a Risk Adjustment Auditor to monitor, audit, and validate coding and documentation for risk adjustment. This role ensures accurate ICD-10 coding across professional, inpatient, and outpatient services.

You will review medical records, stay current with HIPAA and CMS guidelines, and collaborate with care teams to maintain compliance and high-quality data. Requires CPC/COC or CRC certification and 5+ years of clinical coding experience in risk adjustment.

Qualifications

• Associates degree or combination of relevant education and experience.
• 5+ years of clinical coding experience with risk adjustment coding.
• CPC/COC or CRC certification required with other certifications considered on a case-by-case basis.

Responsibilities

• Conducts coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes to ensure compliance.
• Reviews patient medical records to identify relevant diagnoses and capture information for accurate coding.
• Assigns appropriate ICD-10 codes to document patient conditions and ensure compliance with guidelines and regulations.
• Stays updated with HIPAA, coding guidelines, regulations, and compliance standards to maintain accuracy.
• Meets team performance metrics for quantity and quality.
• Conducts RADV/IPM Chart Review duties as assigned.
• Participates in Coding Advisory Committee.

Skills

ICD-10 coding

Auditing

Medical terminology

Communication

Problem solving

Organizational skills

Independent work

Education

Associates degree or equivalent experience

Job description

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

The Risk Adjustment Auditor is responsible for the ongoing monitoring, quality assurance, auditing and validating coding and documentation for the risk adjustment. The Auditor is responsible for auditing medical record documentation to ensure use of accurate medical coding of all professional, inpatient and outpatient services, procedures, diagnoses, and conditions in support of compliant risk adjustment program. This work is performed utilizing the Official ICD Guidelines for Coding and Reporting, MPHC Internal Guidelines, AHA Coding Clinics, CMS RADV Auditor Guide, and all other MPHC organization guidelines, policies, and procedures.

Job Description

Primary Duties & Responsibilities:

• Conducts coding, documentation, and validation audits of medical records and clinical data for risk adjustment vendors and other targeted universes to ensure compliance.
• Reviews patient medical records, including physician notes, lab results, and diagnostic reports, to identify relevant diagnoses and capture essential information for accurate coding
• Assigns appropriate ICD-10 codes to document and accurately represent the patient's conditions and ensure compliance with coding guidelines and regulations.
• Stays updated with changes in HIPAA protocol's, coding guidelines, regulations, and compliance standards to maintain accuracy and compliance within the coding process.
• Meets team performance metrics for both quantity of work completed and quality audit scores.
• Conducts RADV/IPM Chart Review duties as assigned
• Periodically participates in Coding Advisory Committee

Education/Experience:

• Associates degree or combination of relevant education and experience
• 5+ years clinical coding experience, as well as experience in risk adjustment coding experience

Required License(s) and/or Certification(s):

• Certified Coder (CPC/COC) or Certified Risk Coder (CRC) required with other coding certifications considered on a case-by-case basis

Skills/Knowledge/Competencies (Behaviors):

• Proficient understanding of ICD9/10 CM, CPT, and other specialty system coding guidelines as required by diagnostic category
• Strong knowledge of medical terminology and chronic disease management
• Strong auditing skills, specific to Medicare Risk Adjustment
• Excellent written and verbal communication skills
• Strong problem-solving skills
• Strong organizational skills
• Ability to relate to different types of people and build constructive and effective relationships
• Ability to work independently with minimal supervision

Pay Range:

$75,584.55 - $93,369.15

The pay range above reflects the anticipated base pay range based on a full-time position. Actual compensation will be determined based on factors such as experience, skills, qualifications, and other job-related considerations. Employees may also be eligible for additional compensation, including incentive or commission-based programs, where applicable and subject to the terms of the relevant plan.

In addition to base compensation, we offer a comprehensive benefits package including medical, dental, vision, retirement savings with employer contributions, paid time off (including volunteer time off!), pie day, and other employee benefits.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

Martin's Point complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [e-mail]

Do you have a question about careers at Martin's Point Health Care? Contact us at: [e-mail]