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DaVita Kidney Care · 2 weeks ago

Risk Adjustment Coding Auditor & Educator

Denver, CO

Full-time

Onsite

Mid Level

$58K/yr - $85K/yr

3+ years exp

DaVita Kidney Care is seeking a highly motivated and experienced Risk Adjustment Auditor and Educator to join their Coding team. This role is crucial for ensuring the accuracy, integrity, and compliance of risk adjustment coding and clinical documentation, while also providing targeted education to providers and coding teams.

Health CareHospitalMedicalNutrition

Responsibilities

Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes and ensure documentation supports submitted diagnoses for Medicare Risk Adjustment (HCC coding)

Perform detailed internal and external coding audits on a regular basis as defined by compliance & department requirements, including for our nephrology partners

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, summarizing findings, identifying risk areas, and recommending corrective action plans

Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits, by preparing documentation and responding to inquiries

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, tailoring content to address specific needs and knowledge gaps

Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions

Stay current with official coding guidelines from CMS, HHS, and other regulatory bodies to ensure all educational content is accurate and up-to-date

Maintain meticulous records of audit findings, educational sessions, and follow-up actions to ensure a clear audit trail

Participate in special projects related to process improvement, compliance, and coding initiatives as assigned

Maintain strict confidentiality of patient and proprietary information

Demonstrate and exemplify behavior consistent with DaVita’s core values: Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment, and Fun

Qualification

ICD-10-CMCMS-HCC risk adjustmentMedical auditingEducationTrainingEMR systemsAnalytical skillsCommunication skillsProblem-solving skillsAttention to detail

Required

Current coding certification from AAPC or AHIMA is required (CCA and CPC-A are not accepted)

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

Excellent verbal and written communication skills, with the ability to present complex information clearly

Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail

Demonstrated ability to work independently and collaboratively in a fast-paced, team-oriented environment

Preferred

Proven experience in developing and delivering education and training to clinical providers and coders is highly preferred

Benefits

Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out

Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more

Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning.

Company

DaVita Kidney Care

Glassdoor3.4

DaVita means “to give life,” reflecting our proud history as leaders in dialysis—an essential, life-sustaining treatment for those living with end stage kidney disease (ESKD).

Founded in 1979

Denver, Colorado, USA

10001+ employees