Certified Risk Adjustment Auditor

A company is looking for an Individual & Family Plans (IFP) Quality Review and Audit Analyst. Key Responsibilities Conduct medical records reviews and accurate diagnosis code abstraction following relevant coding guidelines Utilize the Risk Adjustment Model to ensure accuracy of Hierarchical Condition Categories (HCC) from ICD-10-CM codes Perform documentation audits to identify gaps in risk adjustment data and compliance risks Required Qualifications High school diploma and at least 2 years of experience with relevant coding certifications (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC) Experience with medical documentation audits and proficiency in ICD-10-CM coding guidelines Familiarity with CMS regulations for Risk Adjustment programs Computer competency with Excel, MS Word, and Adobe Acrobat Ability to meet productivity and accuracy standards