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Atlantic Group

QHP Auditor

Atlantic Group, WorkFromHome

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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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