Risk Adjustment Analyst - NC Licensed

Job Summary

A company is looking for a Risk Adjustment Analyst- HIM OP CDI.

Key Responsibilities

• Analyze and audit medical records for payer audits under Value Care contracts
• Review HCC Edit WQ cases to reorder diagnoses for claim billing
• Conduct pre-visit medical record reviews to ensure accurate documentation of HCC conditions

Required Qualifications

• High school diploma or GED required
• Successful completion of the OP CDI Proficiency Test
• Certification from AHIMA, AAPC, ACDIS, or relevant nursing licenses required
• Minimum of twelve months of OP coding or nursing experience in an ambulatory care setting
• Strong knowledge of medical record documentation and coding guidelines