Risk Adjustment Auditor - Remote

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

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Retirement plan

Paid time off

Volunteer time off

Pie day

Job summary

Martin's Point Health Care Inc. is seeking a Risk Adjustment Auditor to ensure accurate ICD-10 coding and compliant documentation across professional, inpatient, and outpatient services.

You will audit medical records, review physician notes and labs, assign ICD-10 codes, and stay current with CMS RADV guidelines while meeting quality metrics and collaborating with teams.

Qualifications

• Associates degree or combination of relevant education and experience in clinical coding.
• 5+ years clinical coding experience with risk adjustment coding experience.
• CRC or CPC/COC certification required; other coding certifications considered on a case-by-case basis.
• Strong knowledge of ICD-10-CM, CPT and related coding guidelines.

Responsibilities

• Audits medical records and validates coding for risk adjustment programs.
• Reviews physician notes, labs and reports to capture diagnoses for accurate coding.
• Assigns ICD-10 codes to document patient conditions in compliance with guidelines.
• Keeps up-to-date with HIPAA, coding rules and RADV requirements; meets quality metrics.

Skills

Auditing

ICD-10 Coding

Medicare Risk Adjustment

Communication

Medical Terminology

Organizational Skills

Education

Associate degree

CRC Certification

CPC/COC Certification

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 SummaryThe 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 DescriptionPrimary 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 codingAssigns 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 assignedPeriodically participates in Coding Advisory CommitteeEducation/Experience:Associates degree or combination of relevant education and experience5+ years clinical coding experience, as well as experience in risk adjustment coding experienceRequired 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 basisSkills/Knowledge/Competencies (Behaviors):Proficient understanding of ICD9/10 CM, CPT, and other specialty system coding guidelines as required by diagnostic categoryStrong knowledge of medical terminology and chronic disease managementStrong auditing skills, specific to Medicare Risk AdjustmentExcellent written and verbal communication skillsStrong problem-solving skillsStrong organizational skillsAbility to relate to different types of people and build constructive and effective relationshipsAbility to work independently with minimal supervisionThere are additional competencies linked to individual contributor, provider, and leadership roles. Please consult with your leader to discuss additional competencies that are relevant to your position.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] you have a question about careers at Martin’s Point Health Care? Contact us at: [e-mail]