To ensure accurate risk adjustment data submission to CMS, the full-time Remote Medicare Risk Adjustment Compliance Auditor will conduct provider and coder level reviews, develop tracking tools, and monitor compliance with federal and state regulations.
Key responsibilities
Conduct audits and reviews of coding practices to identify outliers and ensure compliance with CMS regulations
Develop and maintain tracking tools for risk adjustment compliance and monitor corrective action plans
Collaborate with Risk Adjustment Management to validate data accuracy and support coding audits
Required qualifications
Minimum 3 years of professional coding experience in a medical group or health plan setting
Bachelor's degree in business administration, health care management, or a related field, or 4 years of additional experience in lieu of education
Certified Coder (CPC, CCS, or CCS-P) required
Experience with strategic planning in risk mitigation
Proficient in MS Office Suite; experience with Epic, Allscripts, or EZCap is a plus