Risk Adjustment AuditorActive$83K–$109K
The opportunity
Hi, we're Oscar. We're hiring a Associate, Risk Adjustment Auditor to join our Risk Adjustment team.
What you'll do
Responsible for daily operations pertaining to Risk Adjustment including but: not limited to: medical record reviews to report ICD-10-CM diagnosis codes for ACA and MA lines of business, potential Centers of Medicare & Medicaid Services (CMS), Health and Human Services (HHS) audits and medical record retrieval efforts.
Mitigate risk by validating Encounter Data Gathering Environment Server: (EDGE) data is supported within provider encounter documentation
Review the performance of the Risk Adjustment Coding team and report audit: trends to Leadership in a timely, consistent and effective manner to ensure the appropriate changes and education are implemented.
Maintain compliance with national standards and coding practices set by the: ICD-10-CM coding guidelines for accuracy, as well as compliance with Risk adjustment production standards.
Conduct CMS audits of Risk Adjustment activities, including but not limited: to Risk Adjustment Data Validation audits.
Develop relationships with key individuals to foster an increased: understanding of the Risk Adjustment process.
What they're looking for
- Identify and execute on the creation of clinical document improvement: resources for provider education in both MA and ACA line of business.
- Manage the implementation process improvements that will maximize risk adjustment factor increases.
- Compliance with all applicable laws and regulations
- Other duties as assigned
