9 risk adjustment coding auditor jobs found

A leading healthcare provider in Texas is looking for a Coding Auditor Senior. This on-site role with a remote option involves performing code audits, ensuring accurate documentation, and educating providers on coding practices. The ideal candidate will have at least three years of coding experience, strong communication skills, and certification through AHIMA or AAPC. The position requires a commitment to comply with guidelines and improve coding accuracy to enhance care quality and regulatory compliance. #J-18808-Ljbffr

Description Summary: Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs, including but not limited to Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation). This is an on-site position with a remote option. Responsibilities: Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment....

Job Description The Compliance Auditor, Billing and Coding Compliance is responsible for the oversight and management of auditing and monitoring billing and coding compliance activities, assist with internal compliance policies and procedures, completing compliance risk assessments, and developing risk-based educational materials to ensure compliance with federal/state laws and regulations, and UT Health San Antonio policies. Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. Responsibilities Provide oversight on billing compliance auditing, monitoring, and educational activities within the compliance department. Performs audits of electronic and manual documentation, coding, and billing systems. Conducts close-out meetings with senior management of audited departments. Maintain current knowledge of changes in federal and state coding and billing regulations/guidelines...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation. Supervisory Responsibilities: This position has no supervisory responsibilities. General Requirements: All duties performed will be done accurately and in a timely manner. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers. Must always adhere to customer service expectations including in-person and virtual (via...

Hi, we're Oscar. We're hiring a Risk Adjustment Coder Specialist to join our Risk Adjustment. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS) , and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be...

A healthcare provider organization in Houston seeks a Risk Adjustment Coding Specialist II to ensure compliance with Medicare documentation requirements, conduct audits, and mentor staff. Candidates must have 3-5 years of experience in risk adjustment coding, relevant certification, and reliable transportation for travel. This position follows a hybrid model requiring travel to provider offices, offering a competitive salary between $70,000 and $85,000 per year. #J-18808-Ljbffr

Risk Adjustment Coder Specialist Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselvesone that behaves like a doctor in the family. About the role: The Senior Specialist, Risk Adjustment for Medicare Advantage (MA) and Affordable Care Act (ACA) lines of business will work closely with management to meet communicated individual and departmental goals, deadlines set forth by Centers for Medicare & Medicaid Services (CMS) and Health and Human Services (HHS), and be active and engaged in establishing effective Risk Adjustment processes. You will report into the Manager, Risk Adjustment. Work location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for...

Job Type Full-time Description At VMG Health, we're more than just a team of experts; we're trusted partners in the business of healthcare. Backed by a team of over 300 professionals and a history of more than 70,000 engagements since 1995, we bring experience, deep and wide, to every project. Our national client base ranges from large health systems to small practices and everything in between, including investors and private equity firms. Our solutions-oriented approach to client needs is bolstered by our strong market position, extensive contacts, unparalleled tools and solutions, and expert insights. We are proud to serve as the single source for all our clients' valuation, strategic, and compliance needs. Requirements VMG Health is seeking a Coding/Compliance Auditor to perform all levels of documentation and coding reviews related to professional services as well as project management and report writing for VMG's Coding Audit and Compliance (CAC) team. The...