Certified Risk Adjustment Auditor

Job Summary

A company is looking for an Individual & Family Plans (IFP) Quality Review and Audit Analyst.

Key Responsibilities

• Conduct medical records reviews and accurate diagnosis code abstraction following relevant coding guidelines
• Utilize the Risk Adjustment Model to ensure accuracy of Hierarchical Condition Categories (HCC) from ICD-10-CM codes
• Perform documentation audits to identify gaps in risk adjustment data and compliance risks

Required Qualifications

• High school diploma and at least 2 years of experience with relevant coding certifications (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC)
• Experience with medical documentation audits and proficiency in ICD-10-CM coding guidelines
• Familiarity with CMS regulations for Risk Adjustment programs
• Computer competency with Excel, MS Word, and Adobe Acrobat
• Ability to meet productivity and accuracy standards