Senior Risk Adjustment Auditor II (Hybrid/Remote)

Cambia Health Solutions

Lewiston (ID)

Hybrid

USD 65,000 - 100,000

Full time

5 days ago

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Benefits offered by this job

Medical, dental and vision coverage

Health savings account contributions

Paid time off and holidays

401(k) with company match

Parental leave

Wellness programs

Employee Assistance Fund

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 verify codes, identify trends, and collaborate on improvement strategies in a collaborative team.

The ideal candidate has an associate degree in healthcare or related field with relevant coding experience and CPC/CRC certification.

Qualifications

Associate degree in Healthcare or related field with 1 year of experience for Auditor I; 3 years for Auditor II.
Risk Adjustment, HCC or Inpatient coding experience required.
CPC and CRC coding certification required.
Knowledge of ICD-9-CM/ICD-10 coding guidelines and auditing best practices.

Responsibilities

Perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting.
Conduct quality reviews of vendor coding in support of risk adjustment processes.
Verify accuracy and completeness of provider-reported diagnosis codes.
Identify trends in coding/documentation and collaborate on intervention strategies.
Mentor junior staff and participate in special risk mitigation projects.