Quality Review and Audit Analyst

Role Overview

• Proficient in assigning accurate ICD-10 diagnosis codes
• Audits accuracy of abstracted diagnostic codes from identified medical record cohorts
• Performs claims matching and auditing, identifying missing or inaccurate data within RA claims
• Leads, trains, or mentors junior team members
• Collaborates and coordinates with stakeholders to facilitate coding and risk adjustment education
• Contributes expertise to creation and maintenance of Coding Guidelines and Best Practices
• Participates in RADV execution for designated markets

Requirements

• High School Diploma or equivalent; Bachelors or equivalent work experience preferred
• 5+ years’ experience in medical record coding
• certification in good standing from either the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), in one or more of the following: Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Risk Adjustment Coder (CRC)
• Willing to achieve CRC certification within 12 months of hire, if not previously certified
• Experience with Risk Adjustment coding and HCCs
• Competency with MS Excel, MS Word, Adobe Acrobat, or other comparable software
• Must be detail oriented, self-motivated, and have excellent organization skills
• Ability to work independently, managing time to meet deadlines, timelines, productivity, and accuracy standards for program success

Benefits

• medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• company paid life insurance
• tuition reimbursement
• a minimum of 18 days of paid time off per year
• paid holidays