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Atlantic Group

QHP Auditor

Atlantic Group, Boston, Massachusetts, us, 02298

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Responsibilities

Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. Primarily for QHP (RADV).

Ability to code government and state models, including code everything projects.

Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.

Maintain a 95% accuracy rate on all coding projects.

Assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.

Requirements

Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS‑P, CPC, CIC, etc.). The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.

RADV Experience Mandatory.

Strong organizational skills.

Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel, and Outlook.

Strong written and verbal communication skills.

Ability to work independently in a remote environment.

Private lockable office space to ensure security of member PHI.

Minimum of 7 years coding experience with at least 5 of those years in Risk Adjustment coding.

Completion of an accredited medical coding program with current unencumbered credentials.

Required Education

CPC Certification.

Required Experience

Risk Adjustment coding: 5 years.

Coding: 7 years.

Seniority Level Associate

Employment Type Contract

Job Function Accounting/Auditing

Industries Hospitals and Health Care

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