Apex Systems
Job#: 3016202
Job Description:
Primary Job Purpose: The Risk Adjustment Auditor II performs Retrospective/Prospective chart review both on and off‑site utilizing various types of records to ensure accurate risk adjustment reporting. Identifies trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies.
Minimum Requirements:
Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
Knowledge of and adherence to Official ICD‑9‑CM/ICD‑10 Coding Guidelines.
Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
Demonstrated ability to identify and communicate trends in provider coding and documentation.
Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
Effective verbal and written communication skills.
Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
Demonstrated ability to provide proactive and creative solutions to business problems.
General Functions and Outcomes:
Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation.
Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
Supports and actively participates in process and quality improvement initiatives.
Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
Consistently meets departmental performance and attendance requirements.
Serves as a mentor to Risk Adjustment Auditor I staff.
Assists with special projects such as risk mitigation reviews.
Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program. Assists with implementation activities as a result of regulatory changes to the Program.
Work Environment:
Location: Remote – Candidates MUST reside in one of the four states in which this client operates: Oregon, Washington, Idaho or Utah.
Expectations of All Contingent Workforce:
Conducts business with high regard for our corporate values and in compliance with its Code of Business Conduct.
Maintains high regard for member and Medicare beneficiary privacy and complies with the client’s Corporate Privacy and information security policies.
Contributes to the achievement of our Corporate Affinity Action goals and objectives.
Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company's quality initiative.
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.
Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Accounting/Auditing and Finance
Industries:
IT Services and IT Consulting
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Job Description:
Primary Job Purpose: The Risk Adjustment Auditor II performs Retrospective/Prospective chart review both on and off‑site utilizing various types of records to ensure accurate risk adjustment reporting. Identifies trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies.
Minimum Requirements:
Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
Knowledge of and adherence to Official ICD‑9‑CM/ICD‑10 Coding Guidelines.
Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
Demonstrated ability to identify and communicate trends in provider coding and documentation.
Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
Effective verbal and written communication skills.
Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
Demonstrated ability to provide proactive and creative solutions to business problems.
General Functions and Outcomes:
Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider‑reported diagnosis codes based on medical record documentation.
Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.
Supports and actively participates in process and quality improvement initiatives.
Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
Consistently meets departmental performance and attendance requirements.
Serves as a mentor to Risk Adjustment Auditor I staff.
Assists with special projects such as risk mitigation reviews.
Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program. Assists with implementation activities as a result of regulatory changes to the Program.
Work Environment:
Location: Remote – Candidates MUST reside in one of the four states in which this client operates: Oregon, Washington, Idaho or Utah.
Expectations of All Contingent Workforce:
Conducts business with high regard for our corporate values and in compliance with its Code of Business Conduct.
Maintains high regard for member and Medicare beneficiary privacy and complies with the client’s Corporate Privacy and information security policies.
Contributes to the achievement of our Corporate Affinity Action goals and objectives.
Responsible for quality and continuous improvement within the job scope. Contributes to and supports the company's quality initiative.
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.
Seniority level:
Mid‑Senior level
Employment type:
Full‑time
Job function:
Accounting/Auditing and Finance
Industries:
IT Services and IT Consulting
#J-18808-Ljbffr