Integrated Resources, Inc ( IRI ) · 5 hours ago
Audit Analyst
United States
Contract
Remote
Entry, Mid Level
2+ years expIntegrated Resources, Inc (IRI) is seeking an Audit Analyst to support Individual & Family Plan Risk Adjustment programs. The role involves reviewing medical records, ensuring accurate diagnosis coding, and validating compliance with CMS/HHS guidelines through quality audits and documentation accuracy.
BiotechnologyHealth CareHuman ResourcesRecruitingStaffing Agency
Responsibilities
Review medical records and accurately abstract diagnosis codes following:
Official ICD-10-CM Coding Guidelines
Client IFP Coding Guidelines and Best Practices
CMS/HHS protocols and applicable regulations
Validate HCCs using the HHS Risk Adjustment Model for the correct benefit year
Apply longitudinal review methods to identify complete and valid documentation across time
Perform documentation and data audits to:
Identify gaps, inaccuracies, and compliance risks
Support Risk Adjustment Data Validation (RADV) audits
Support Supplement Diagnosis submission programs
Conduct quality audits for vendor coding partners
Collaborate with internal teams and external partners to support:
Coding education
Risk Adjustment education
Coordinate with stakeholders to ensure efficient and compliant Risk Adjustment programs
Escalate identified risks, trends, and program gaps to management
Communicate effectively through written and verbal communication
Support development and updates of internal processes, coding guidelines, and policy determinations to ensure CMS/HHS compliance
Qualification
Required
High School Diploma or GED
Minimum 2 years of experience with one of the following certifications: Certified Professional Coder (CPC), Certified Coding Specialist – Providers (CCS-P), Certified Coding Specialist – Hospitals (CCS-H), Certified Risk Adjustment Coder (CRC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA)
Medical record reviews and documentation audits experience
Strong knowledge of ICD-10-CM coding guidelines and conventions
Familiarity with CMS Risk Adjustment programs and compliance policies
Experience with inpatient and outpatient documentation
HCC coding experience
Proficiency in: Microsoft Excel, MS Word, Adobe Acrobat
Detail-oriented with strong organizational skills
Ability to meet productivity, accuracy, and timeline requirements
HCC Coding experience – minimum 2 years
Active CPC or CCS certification
Intermediate Microsoft Office skills
Preferred
HCC coding experience
Understanding of medical claims submissions
Company
Integrated Resources, Inc ( IRI )
Integrated Resources Inc.
501-1000 employees
Funding
Current Stage
Late StageRecent News
2025-06-11
2025-06-11
2025-04-14
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