Risk Adjustment QA & Auditing Lead - Remote-Eligible

Excellus BCBS; Town of De Witt (NY); Híbrido; USD 72 000 - 129 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Remote work opportunity

Resumo da oferta

Excellus BCBS in New York seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing to oversee the Risk Adjustment QA Auditor team, ensuring accuracy, regulatory compliance, and audit quality. This role collaborates with leadership to drive continuous improvement in audit processes and coding accuracy.

You will lead training, performance management, and process improvement initiatives for internal staff, supporting CMS IPM, CON RADV, and HRADV audits as required.

Qualificações

• Five years ICD-10-CM and HCC coding experience required; familiarity with RADV and HRADV audits.
• Experience supervising or managing people and/or projects.
• Associate degree in health care related field preferred.
• CPC and CRC certifications required; other relevant certifications preferred.
• Strong knowledge of CMS/HHS guidelines and coding rules.
• Excellent written and verbal communication skills.
• Experience with EMR systems.
• Ability to travel as needed.

Responsabilidades

• Provide strategic oversight to a team of Risk Adjustment Quality Assurance Auditors, ensuring all audit activities adhere to state, federal, and corporate standards.
• Direct and coordinate day-to-day operations of the Risk Adjustment QA Audit team, ensuring coding accuracy and regulatory compliance.
• Oversee RADV and HRADV audits across CMS, ICD-10-CM coding, and organizational guidelines.
• Document audit project expectations and parameters, meeting deadlines.
• Coach, mentor, and train audit staff; conduct performance evaluations and regular feedback.
• Ensure audits follow CMS guidelines and organizational policies.
• Monitor audit quality, accuracy rates, and turnaround times; review complex cases as needed.
• Identify process improvements to drive audit accuracy and productivity.

Conhecimentos

ICD-10-CM coding

HCC coding

Leadership

Communication

Project management

EMR systems

Formação académica

Associate degree in health care

Ferramentas

EMR systems

Descrição da oferta de emprego

Excellus BCBS in New York seeks a Supervisor, Risk Adjustment Quality Assurance and Auditing to oversee the Risk Adjustment QA Auditor team, ensuring accuracy, regulatory compliance, and audit quality. This role collaborates with leadership to drive continuous improvement in audit processes and coding accuracy.

You will lead training, performance management, and process improvement initiatives for internal staff, supporting CMS IPM, CON RADV, and HRADV audits as required.