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Risk Adjustment Clinical Auditor & Documentation Specialist
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- The Risk Adjustment Clinical Auditor and Documentation Specialist is responsible for conducting retrospective and concurrent medical reviews to ensure the medical record is compliant both in HEDIS Measures, Risk Adjustment documentation standards and code capture according to the national guidelines.
- Provide feedback to Director of Risk Adjustment and Chief Clinical Officer on performance improvement opportunities tracks and prioritizes projects to improve coding and documentation outcomes.
- Review documentation of well visits (annual well visits and other routine and preventative visits) including the use of appropriate modifiers for telehealth visits, HEDIS scoring accuracy, etc.
- Monitor internal reporting for coding/CPT outliers, stays up to date with CMS audit processes and actively participates in all audits as they relate to risk adjustment.
- AAPC certification(s): CPC or COC plus CRC, CPMA, and/or CDEO.
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