Auditor, Risk Adjustment

1+ year(s) experience Quality Auditing and/or Risk Adjustment Data Validation Audit (RADV) experience

Experience coding in a variety of different Electronic Medical Record (EMR) systems.

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The Associate, Risk Adjustment Auditor conducts internal and external quality audits.

Quality audits are specific to ICD-10 code abstraction relative to accuracy, completeness, and identified clinical documentation improvement opportunities.

You will work with management to implement benchmarks, establish acceptable thresholds, and quality assurance programs.

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.