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Risk Adjustment Coding Auditor
Location
Texas
Posted
118 days ago
Salary
$57.8K - $85K / year
Seniority
Senior
Job Description
Risk Adjustment Coding Auditor
DaVita Kidney Care
• Auditing, Analysis, and Compliance • Ensure that IKC is compliant with industry regulations and published coding guidelines • Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes • Perform detailed internal and external coding audits on a regular basis as defined by compliance requirements • Execute targeted audit plans, including performing targeted audits of identified HCC outliers • Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings • Prepare and present formalized audit reports to leadership • Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits • Perform necessary research to provide supportive regulatory and coding guideline documentation • Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines • Provide one-on-one and group education sessions based on audit findings
Job Requirements
- Current coding certification from AAPC or AHIMA is required
- 3+ years of coding experience
- 2-3 years’ minimum recent experience performing medical audits for diagnosis coding
- Strong computer skills, including the ability to utilize various EMR systems and Microsoft Office
- Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models
- Deep understanding of coding and documentation compliance, including CMS and HHS regulations
- High school diploma or equivalent required
- Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred
Benefits
- Medical, dental, vision
- 401(k) match
- Paid time off
- PTO cash out
- Family resources
- EAP counseling sessions
- access Headspace ®
- backup child and elder care
- maternity/paternity leave
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