Senior Risk Adjustment Auditor II – Mentor & Impact

Cambia Health Solutions; Portland (OR); Hybrid; USD 58.000 - 94.000; Vollzeit

Benefits dieser Stelle

Medical, dental and vision coverage

Generous paid time off

Market-leading retirement plan

Zusammenfassung

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. The role includes quality reviews of vendor coding, verifying provider-reported codes against medical records, and identifying coding trends to guide intervention strategies.

This hybrid role requires an Associate degree in healthcare and either one or three years of related experience, depending on level.

Qualifikationen

• Associate degree in Healthcare or related field.
• Experience in clinical coding or auditing is preferred.
• Risk Adjustment, HCC or Inpatient coding experience required.

Aufgaben

• 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 accuracy and completeness 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 documents actionable insights for intervention strategies.

Kenntnisse

Risk adjustment auditing

Chart reviews

Quality audits

ICD-9-CM/ICD-10 guidelines

Analytical ability

Verbal and written communication

AI tools knowledge

Ausbildung

Associate degree in Healthcare or related field

Tools

Word

Excel

Outlook

Jobbeschreibung

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. The role includes quality reviews of vendor coding, verifying provider-reported codes against medical records, and identifying coding trends to guide intervention strategies.

This hybrid role requires an Associate degree in healthcare and either one or three years of related experience, depending on level.