CareOregon

Making health care work for everyone.

Senior Risk Adjustment Coding Auditor

Full TimeRemoteTeam 501-1,000Since 1994Company SiteLinkedIn

Location

Idaho + 4 moreAll locations: Idaho, Oregon, Texas, Utah, Wisconsin

Posted

2 days ago

Salary

$81K - $99K / year

Professional Certificate5 yrs expEnglish

Job Description

• Perform and lead a variety of coding-related audits for providers and other entities • Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data • Communicate audit results and recommendations for improvement to providers when needed • Create and maintain processes for tracking audit results and outcomes of reviews • Identify, track, analyze and report on any trends revealed in audits • Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders • Lead the development of educational materials and process documentation in a variety of mediums • Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations • Maintain active coding certification • Seek out emerging coding best practices • Serve as subject matter expert regarding correct coding practices • Collaborate with Risk Adjustment team to create SOPs and contribute to roadmaps for Risk Adjustment Coding initiatives • Onboard and train new Coding Auditors

Job Requirements

  • Minimum 5 years’ experience as a certified coder
  • Current coding certification from AHIMA or AAPC
  • One-year experience with risk adjustment program in a Health Plan
  • Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO) preferred
  • Experience leading group educational presentations and teaching to medical professionals
  • 5 years’ experience with CMS, HHS and/or CDPS+RX Hierarchical Condition Categories (HCC) models
  • Experience with or knowledge of risk adjustment principles

Benefits

  • Health insurance
  • Dental coverage
  • Vision insurance
  • Life insurance
  • AD&D insurance
  • Disability insurance
  • Health savings account
  • Flexible spending account(s)
  • Lifestyle spending account
  • Employee assistance program
  • Wellness program
  • Discounts and supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
  • Retirement plan with employer contributions
  • Paid time off (PTO) and Paid State Sick Time based on hours worked
  • Paid holidays, volunteer time, jury duty, and bereavement leave

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