Risk Adjustment Auditor

We’re unique.  You should be, too.

We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Risk Adjustment Auditor works in a collaborative effort directly with physicians, their office staff, and other support departments to review medical records and other clinical documentation to identify appropriate medical charts and records for compliance with federal coding regulations and guidelines. A major focus of the position is to ensure that medical documentation and supportive evidence complies with risk adjustment initiatives, improving revenue cycle and denial of payments.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Audits medical record documentation to identify under-coded and up-coded services; prepares reports of findings and meets with providers to provide education and training on accurate coding practices and compliance issues.
• Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, denials, and billable services.
• Interacts with other patient care providers regarding policies, procedures, and regulations; obtains clarification on conflicting, ambiguous, or non-specific documentation.
• Instructs, and/or provides support to medical providers and medical coding analysts as appropriate regarding coding compliance documentation, and regulatory provisions.
• Reviews, develops, modifies, and/or adapts relevant procedures, protocols, and data management to ensure that Medical Risk Adjustment operations meet the requirements.
• Interacts with providers and management to review and/or implement codes and to update documentation.
• Ensures strict confidentiality of all records.
• Attends coding conferences, workshops, and in-house sessions to receive updated coding information and changes in coding and/or regulations.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of auditing concepts and principles
• Advanced knowledge of medical coding (ICD-10) and billing systems, medical terminology, procedures, documentation and regulatory requirements
• Ability to use independent judgment to analyze and solve problems
• Strong follow-up skills, organizational and time management skills required
• Excellent written and verbal communication and interpersonal skills; fluency in English
• Knowledge of legal, regulatory, and policy compliance issues related to medical coding and billing procedures and documentation
• Knowledge of current and developing issues and trends in medical coding procedures requirements
• Ability to clearly communicate medical information to professional practitioners and/or the general public and to provide guidance and training to professional and technical staff
• Ability to adapt and modify medical billing procedures, protocol, and data management systems to meet specific operating requirements
• Strong proficiency with Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook
• Ability and willingness to travel locally, regionally and nationwide up to 10% of the time

EDUCATION AND EXPERIENCE CRITERIA:

• High school diploma or GED required; experience may substitute for education on a year-for-year basis
• Minimum 3 years of experience directly related to the duties and responsibilities specified
• CRC (Certified Risk Coder) is required, or additional 3 years’ experience in risk adjusting coding in lieu of certification
• Technical certification in CPMA Medical Coding or related field
• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis