Medicare Risk Adjustment Compliance Auditor (CPC, CCS, or CCS-P Required) (Remote)
Core
Conduct provider and coder level reviews and audits to ensure accurate risk adjustment data is submitted to CMS, while developing tracking tools and monitoring corrective action plans.
Role type
Risk Adjustment Compliance Auditor
Builds
Risk adjustment data submissions to CMS and internal compliance tracking tools
Domain
Healthcare / Risk Adjustment Coding
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Medical coding (CPC, CCS, CCS-P), Risk adjustment auditing, CMS audit processes, Data validation, Regulatory compliance (HIPAA, federal/state/local), Statistical report analysis, Strategic planning in risk mitigation
Preferred skills
Epic, Allscripts, EZCap experience, Certified Auditor, MS Access proficiency
Technologies
Epic, Allscripts, EZCap, MS Office suite, MS Access
Responsibilities
Monitor coding prevalence reporting for outliers; Review IPA Policies and procedures; Monitor internal and vendor coding staff accuracy percentages; Collaborate on data validation and RADV coding audits; Maintain comprehensive tracking tools; Ensure compliance with regulations; Monitor HCC Corrective Action Plans; Represent the department in audits
Seniority
Mid-level, hands-on IC
