Note: The job is a remote job and is open to candidates in USA. Integrated Resources, Inc (IRI) is seeking a Quality Review and Audit Analyst who will bring medical coding and Hierarchical Condition Category expertise to evaluate complex medical conditions and ensure compliance of medical documentation. The role involves conducting medical records reviews, performing audits, and collaborating with team members to improve data and processes for Continuous Quality Improvement (CQI).
Responsibilities
- Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, IFP Coding Guidelines and Best Practices, HHS Protocols and any additional 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 data capture, through the lens of HHS’ Risk Adjustment
- Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment 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 submission program. Inclusive of Quality Audits for vendor coding partners
- Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners
- Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or 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, including contributing to IFP Coding Guideline updates and policy determinations, as needed
Skills
- High school diploma
- 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
- Experience with medical documentation audits and medical chart reviews
- Proficiency with ICD-10-CM coding guidelines and conventions
- Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation
- Computer competency with excel, MS Word, Adobe Acrobat
- Must be detail oriented, self-motivated, and have excellent organization skills
- Ability to meet timeline, productivity, and accuracy standards
- HCC Coding Exp (2 yrs)
- Certified Professional Coder (CPC or CCS)
- Microsoft Office Skills (Medium)
- HCC coding experience preferred
- Understanding of medical claims submissions is preferred
Benefits
- 100% Remote
- Flexible 8 hour shift
- Training schedule 9am - 5pm EST
Company Overview
Company H1B Sponsorship