HireTalent - Staffing & Recruiting Firm · 14 hours ago
Quality Review and Audit Analyst
Franklin, TN
Full-time
Onsite
Entry, Mid Level
2+ years expHireTalent is a staffing and recruiting firm seeking a Quality Review and Audit Analyst. The role involves evaluating medical documentation, ensuring compliance, and identifying trends to improve data processes for Continuous Quality Improvement in Risk Adjustment programs.
DeliveryHuman ResourcesStaffing Agency
Responsibilities
Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, 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 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
HCC coding experience
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
Preferred
HCC coding experience preferred
Understanding of medical claims submissions is preferred
Company
HireTalent - Staffing & Recruiting Firm
HireTalent is a certified Minority Business Enterprise (MBE) workforce solutions firm, specializing in securing the best talent fits in Executive/Retained Search, Direct Hire Placements, MSP, SOW, and nationwide hiring program management and support.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ashish Kaushal
CEO / Founder
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