QHP Auditor (AHA)

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. This includes code everything projects.
Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state
and federal regulations.
Ability to maintain a 95% accuracy rate on all coding projects.
Coders 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
Supervision Received
General supervision is received weekly