Risk Adjustment Auditor
Our client is seeking a Risk Adjustment Auditor to perform detailed retrospective and prospective chart reviews, both on and off-site, ensuring precise risk adjustment reporting. This role involves collaborating closely with provider teams to identify coding trends and support intervention strategies.
This role is fully remote for candidates who reside in the continental United States. This role operates on an 8-hour shift during core hours from 6:00 am to 5:00 pm Pacific Time, with candidates required to work Pacific Time Zone hours, including potential overtime and weekends as needed.
Risk Adjustment Auditor Responsibilities
- Conduct comprehensive retrospective and prospective chart reviews to validate risk adjustment reporting.
- Ensure accuracy, completeness, and relevance of provider-submitted diagnosis codes based on medical documentation.
- Review medical records to capture diagnosis codes accurately, aligned with CMS HCC categories.
- Identify trends in provider coding and documentation and work with Provider Education Consultants on intervention strategies.
- Participate actively in process and quality improvement initiatives to enhance program effectiveness.
- Maintain updated knowledge of regulatory mandates and ensure all activities comply with requirements.
- Consistently meet performance and attendance standards as set by the department.
- Serve as a mentor to junior Risk Adjustment Auditors, offering guidance and expertise.
- Support special projects, including risk mitigation reviews, as needed.
- Act as a subject matter expert in the risk adjustment process and coding requirements.
- Monitor and interpret regulatory changes impacting the Risk Adjustment Program, assisting in implementing updates.
Risk Adjustment Auditor Qualifications
- Education and Experience: Associate degree in Healthcare or related field, with a minimum of three years in clinical coding or auditing, or equivalent combination of education and experience.
- Certifications: Required CRC - Certified Risk Adjustment Coder and CPC - Certified Professional Coder certifications.
- Skills and Knowledge:
- Proven experience in performing thorough and accurate chart reviews for risk adjustment.
- In-depth knowledge of ICD-9-CM/ICD-10 coding guidelines and risk adjustment practices.
- Strong analytical abilities to identify, develop, and implement solutions in response to coding trends.
- Effective communication skills, both verbal and written, with the ability to convey trends and provide feedback to providers.
- Proficiency in PC skills and familiarity with standard corporate software (Word, Excel, Outlook).
- Solid understanding of healthcare operations, reimbursement methodologies, and coding conventions across governmental and commercial products.
- Capability to offer innovative, proactive solutions to business challenges and support ongoing quality improvements.
Compensation:$28-$30/hr. (DOE)
VanderHouwen Contractors Enjoy Exceptional Benefit Perks!
As an eligible contract employee with VanderHouwen, you'll have access to a full suite of benefits designed with your well-being in mind. Our comprehensive package includes medical, dental, vision, life insurance, short- and long-term disability, and a matching 401(k) to help secure your future.
Meet VanderHouwen
What kind of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? VanderHouwen does, and we're in it for the long game! Our recruiters focus on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' staffing needs and workplace cultures. This approach helps us find an ideal job match that aligns with your unique career aspirations and goals.
VanderHouwen is an award-winning, Women & Diversity-Owned, WBENC certified professional staffing firm. Founded in 1987, VanderHouwen places experienced professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, Human Resources, or Accounting and Finance career markets. Partner with us to land your next exciting career!
VanderHouwen is an Equal Opportunity Employer and participates in E-Verify. VanderHouwen does not discriminate based on race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws.
#LI-Remote