Senior Risk Adjustment QA & Auditing Leader

Excellus BCBS; City of Albany (NY); Híbrido; USD 72.000 - 129.000; Jornada completa

Descripción de la vacante

Excellus BCBS seeks a Supervisor for Risk Adjustment Quality Assurance and Auditing to oversee a team of auditors. You will ensure accuracy, compliance, and quality of risk adjustment coding and documentation audits in line with CMS and state requirements.

You will lead training, conduct evaluations, and drive process improvements. Collaboration with leadership will prioritize IPM, RADV, and HRADV audits and ensure timely delivery.

Formación

• Five (5) years ICD-10-CM and HCC coding experience required with RADV/HRADV audits.
• Experience supervising or managing people and/or projects.
• Associate’s degree in a health care related field preferred.
• CPC and CRC certifications required; other coding certs preferred.
• Knowledge of CMS/HHS RADV, ICD-10 coding rules, and data validation.

Responsabilidades

• Provide strategic oversight and supervision to a team of Risk Adjustment Quality Assurance Auditors.
• Direct day-to-day operations ensuring coding accuracy and regulatory compliance.
• Oversee RADV, IPM, and HRADV audits and report progress to leadership.
• Coach, mentor, and train staff; conduct performance evaluations and feedback.
• Develop corrective action plans and training materials as needed.

Conocimientos

Leadership experience

Audit experience

CPC/CRC certifications

Strong communication

Educación

Associate degree in healthcare

Herramientas

EMR systems

Descripción del empleo

Excellus BCBS seeks a Supervisor for Risk Adjustment Quality Assurance and Auditing to oversee a team of auditors. You will ensure accuracy, compliance, and quality of risk adjustment coding and documentation audits in line with CMS and state requirements.

You will lead training, conduct evaluations, and drive process improvements. Collaboration with leadership will prioritize IPM, RADV, and HRADV audits and ensure timely delivery.