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Cambia Health Solutions · 10 hours ago

Risk Adjustment Auditor II

Salt Lake City, UT

Full-time

Hybrid

Mid Level

$64K/yr - $106K/yr

3+ years exp

Cambia Health Solutions is dedicated to creating a person-focused and economically sustainable healthcare system. They are seeking a Risk Adjustment Auditor II who will perform chart reviews to ensure accurate risk adjustment reporting and collaborate with Provider Education Consultants to develop intervention strategies.

BiotechnologyHealth CareInformation Technology

Responsibilities

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

Qualification

Coding CertificationRisk Adjustment ExperienceICD-10 Coding GuidelinesAnalytical SkillsChart Review SkillsHealth Systems KnowledgeProficient PC SkillsEffective CommunicationProblem Solving

Required

Associate degree in Healthcare or related field

Three years of experience in clinical coding or auditing or equivalent combination of education and experience

Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required

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

Preferred

RADV, Risk Adjustment, HCC or Inpatient coding experience preferred

Benefits

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.

Annual employer contribution to a health savings account.

Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.

Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).

Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).

Award-winning wellness programs that reward you for participation.

Employee Assistance Fund for those in need.

Commute and parking benefits.