Apex Systems ยท 6 days ago
Risk Adjustment Auditor II
United States
Full-time
Remote
Mid LevelApex Systems is a world-class IT services company that serves thousands of clients across the globe. They are seeking a Risk Adjustment Auditor II to perform retrospective and prospective chart reviews to ensure accurate risk adjustment reporting and to identify trends in provider coding and documentation.
Human ResourcesInformation TechnologyRecruiting
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
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
Benefits
Medical
Dental
Vision
Life
Disability
Other insurance plans that offer an optional layer of financial protection
ESPP (employee stock purchase program)
401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure
HSA (Health Savings Account on the HDHP plan)
SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions
Corporate discount savings program and other discounts
On-demand training program
Access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure
Certification discounts and other perks to associations that include CompTIA and IIBA
Dedicated customer service team for our Consultants that can address questions around benefits and other resources
Certified Career Coach
Company
Apex Systems
Apex Systems, a division of On Assignment, provides organizations with IT staffing solutions to address gaps in their current workforce.
Founded in 1995
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Roger Wahman
Chief Technology Officer - SVP
Andrea Schiola
Global Head of Technology Partnerships, SVP, Principal
Recent News
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