1 risk adjustment auditor coder jobs found

Duties include performing audits of health status by performing primary source validation comparison of medical record documentation to the corresponding paid claim to ensure all risk adjusted diagnosis in the medical record and on the claim align and originate from a valid source.  Core duties and responsibilities include the following: Performs quality reviews on records to validate coding according to the International Classification of Diseases Manual (ICD-10) for diagnoses and coding guidelines. Review medical records to validate diagnosis on the claim are supported by the medical record documentation Review medical records to ensure all relevant diagnosis for a date of service were documented by the provider on the corresponding claim. Works individually and/or within a team to validate the health status which determines the risk score and HCC for health plan members including: Service Code Accuracy (CPT/HCPCS) Diagnosis Codes Accuracy for codes...