Quality Review and Audit Analyst

Schedule Notes:
M-F: 9AM-5PM EST
Start time scheudle flexible after training, no earlier than 7AM EST and no later than 9AM EST (with consecutive 8-hour shift)
Training Schedule: 2 Weeks - 9AM-5PM EST

Responsibilities:

This position is 100% remote and candidates can be sourced from across the US as long as they're able to support the EST schedule.
Please list the candidate's location clearly on their resume.
Candidates cannot have any pre-planned/scheduled time off during the first 30 days of assignment.
Candidates must have a quiet and private working environment.
Candidates must have a reliable, high-speed internet connection.

Skills/Requirements:

TOP 3 NON-NEGOTIABLE SKILLS (OUTSIDE OF CERTIFICATION)
- HCC/Risk Adjustment experience (2 years+)
- Microsoft Office Experience
- Excellent Written and Verbal communication skills

• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CMcoding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation andcoding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
• Computer competency with excel, MS Word, Adobe Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Understanding of medical claims submissions is preferred
• Ability to meet timeline, productivity, and accuracy standards
• Experience working in a remote environment
• Excellent and clear written and verbal communication skills

Education:
The Quality Review & Audit Analyst will have a high school diploma and at least 2 years experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC):

• 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) certification

Conduct medical records reviews with accurate diagnosis code abstraction in accordance with OfficialCoding Guidelines and Conventions, Client IFP Coding Guidelines and Best Practices, HHS Protocols and anyadditional applicable rule set.

• Utilize HHS Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
• Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for datacapture, through the lens of HHS Risk Adjustment.
• Perform various documentation and data audits with identification of gaps and/or inaccuracies in riskadjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs,including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submissionprogram. Inclusive of Quality Audits for vendor coding partners.
• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of codingand Risk Adjustment education with internal and external partners.
• Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risksor program gaps to management in a timely manner.
• Communicate effectively across all audiences (verbal & written).
• Develop and implement internal program processes ensuring CMS/HHS compliant programs, includingcontributing to Client IFP Coding Guideline updates and policy determinations, as needed.

Skills/Requirements:

TOP 3 NON-NEGOTIABLE SKILLS (OUTSIDE OF CERTIFICATION)
- HCC/Risk Adjustment experience (2 years+)
- Microsoft Office Experience
- Excellent Written and Verbal communication skills

• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CMcoding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation andcoding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
• Computer competency with excel, MS Word, Adobe Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Understanding of medical claims submissions is preferred
• Ability to meet timeline, productivity, and accuracy standards
• Experience working in a remote environment
• Excellent and clear written and verbal communication skills

Education:
The Quality Review & Audit Analyst will have a high school diploma and at least 2 years experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC):

• 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) certification