Immediate need for a talented
Quality Review and Audit Analyst. This is a
06+months contract opportunity with long-term potential and is located in
U.S(Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID:26-29718
Pay Range: $27 - $28.5/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:- Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Client IFP Coding Guidelines.
- Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) from abstracted ICD-10-CM diagnosis codes.
- Identify valid data elements and opportunities for data capture through the lens of HHS’ Risk Adjustment.
- Perform documentation and data audits, identifying gaps and compliance risks in support of IFP Risk Adjustment programs.
- Collaborate with team members and partners to facilitate coding and Risk Adjustment education.
- Coordinate with stakeholders to execute efficient and compliant RA programs, raising identified risks to management.
- Communicate effectively across all audiences, both verbally and in writing.
- Develop and implement internal program processes ensuring CMS/HHS compliance.
Key Requirements and Technology Experience:- Key Skills; Active certification from AHIMA or AAPC, such as:
- Certified Professional Coder (CPC)
- Certified Coding Specialist for Providers (CCS-P)
- Certified Coding Specialist for Hospitals (CCS-H)
- Registered Health Information Technician (RHIT)
- Registered Health Information Administrator (RHIA)
- Certified Risk Adjustment Coder (CRC) certification
- 2+ years of experience in medical documentation audits and medical chart reviews.
- Proficiency with ICD-10-CM coding guidelines and conventions.
- Familiarity with CMS regulations for Risk Adjustment programs.
- Basic knowledge of HCC coding preferred.
- Computer competency with Excel, MS Word, and Adobe Acrobat.
- Detail-oriented, self-motivated, and excellent organizational skills.
- Understanding of medical claims submissions is preferred.
- Ability to meet timeline, productivity, and accuracy standards.
Our client is a leading
Healthcare and Insurance Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
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