Mindlance · 13 hours ago
Quality Review and Audit Analyst
Franklin, TN
Full-time
Onsite
Entry, Mid Level
2+ years expMindlance is a company focused on risk adjustment and quality improvement in healthcare. The Quality Review and Audit Analyst will conduct medical records reviews, ensure compliance with coding guidelines, and identify trends and gaps in data to improve processes for Continuous Quality Improvement.
Human Resources
Responsibilities
Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Client IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set
Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year
Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment
Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners
Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners
Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner
Communicate effectively across all audiences (verbal & written)
Develop and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to Client IFP Coding Guideline updates and policy determinations, as needed
Qualification
Required
High school diploma
At least 2 years' experience in one of the following Coding Certifications by either the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC): Certified Professional Coder (CPC), Certified Coding Specialist for Providers (CCS-P), Certified Coding Specialist for Hospitals (CCS-H), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Risk Adjustment Coder (CRC) certification
Experience with medical documentation audits and medical chart reviews
Proficiency with ICD-10-CM coding guidelines and conventions
Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and coding compliance, with both Inpatient and Outpatient documentation
Computer competency with excel, MS Word, Adobe Acrobat
Must be detail oriented, self-motivated, and have excellent organization skills
Ability to meet timeline, productivity, and accuracy standards
3 Non-Negotiable Skills: HCC Coding Exp (2 yrs), Certified Professional Coder (CPC) or CCS, Microsoft Office Skills (Medium)
Preferred
HCC coding experience preferred
Understanding of medical claims submissions is preferred
Company
Mindlance
Mindlance is a Staffing and Recruiting company which provides multi-vertical staffing services
1001-5000 employees
H1B Sponsorship
Mindlance has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (71)
2024 (53)
2023 (37)
2022 (72)
2021 (36)
2020 (40)
Funding
Current Stage
Late StageLeadership Team
R
Rajat Paul Dhall
Co-Founder & Managing Director
V
Vik Kalra
Co-Founder and Managing Director
Recent News
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