Risk Adjustment Clinical Auditor - Analyst job at reputed company - reputed company in US National

Title: Risk Adjustment Clinical Auditor - Analyst Location: reputed company Job type: Remote Time Type: Full Time reputed company: 7263334360 Job reputed company: Salary reputed company: $ 31.89-53.71 USD reputed company has an exciting opportunity for a Risk Adjustment Clinical Auditor/Analyst position in the Medicare department. This is a full time position working Monday through Friday reputed company hours and will be fully remote.. The Clinical Auditor/Analyst is an integral part of the Risk Adjustment Department and is responsible for reviewing and auditing medical records for Hierarchical Condition Category (HCC) diagnosis codes for reputed company claims reviews and government audits. Performs medical records reviews, and auditing functions including monitoring, reviewing, and researching ICD-10-CM diagnosis codes and CPT Codes. Ensure HCC diagnosis reputed company(s) are supported reputed company the audit year, and utilize AHA Coding clinics, ICD-10-CM Coding Guidelines, CPT Coding Guidelines, and government regulations. Participate in government audits conducting research of internal systems and abstracted records of member's selected for audit. Responsibilities: Utilize reputed company coding guidelines and principles, coding clinics, government regulations and protocols to verify the appropriate ICD-10-CM diagnosis reputed company are correctly assigned by internal or external providers, vendors or staff. Ensuring the member's HCC(s) are supported reputed company the member medical records for the specified audit period or review time reputed company. Participate in government Risk Adjustment Data Validation audits (RADV) conducting research of internal systems verifying member HCC(s) selected for audit meet ICD-10-CM, AHA coding clinics and government submission reputed company. Knowledge of Medicare and reputed company reputed company RADV audits, protocols, guidelines, record submission, audit tools and websites. Review and analyze medical records utilizing their knowledge of anatomy, physiology, medical terminology and pathology and associated clinical processes reputed company to the appropriateness of coding, clinical care, documentation, and health plan business rules. Accurately review the assigned HCC diagnosis codes and apply the appropriate inpatient or outpatient coding guidelines, AHA coding clinics, ICD-10-CM or government regulations. Review provider coding/billing trends, and government audit reputed company to identified HCC coding improvement and opportunities. Work in collaboration with appropriate Health Plan departments including reputed company Assurance, Medicare, and the Fraud, Waste team to facilitate the reputed company of coding issues, reputed company review reputed company, government audit reputed company, or reputed company reviews. reputed company a clinical opinion for special reputed company or various issues including appropriate diagnosis coding, provider coding trends or identify area's of provider documentation improvements. Maintain or exceed designated reputed company and production goals. Maintain employee/insured confidentiality. Participate in training programs to reputed company a thorough understanding of the materials presented. Obtain CPE or CEU's to maintain nursing license, and/or reputed company designations. reputed company 6 months of hire complete the reputed company CPC certification course and sit and pass the CPC certification exam. Review the discharge reputed company, history and physical, physician reputed company notes, consultation reports, radiology, laboratory, pathology, reputed company records, emergency room record to ensure the accurate assignment of diagnosis and / or procedure codes. Communicate effectively with team members, departmental staff and reputed company vendors as necessary to address issues and concerns. Registered reputed company (RN), or Bachelor of Science in Nursing (BSN). Five years of clinical experience. Two years of either HCC coding, reviews or education, DRG experience, Clinical Documentation Improvement, Fraud & Abuse, Chart Auditing, or reputed company Review experience required. Ability to analyze diagnosis codes, maintain designated production standards, and organize multiple reputed company and tasks. In-depth knowledge of medical terminology,ICD-10-CM and CPT-4 coding. Knowledge of health insurance products and various lines of business. Detail- oriented individual with excellent organizational skills. Keyboard dexterity and accuracy. High level of oral and written communication skills. Proficiency with reputed company Office products (reputed company, reputed company, and Word). Licensure, Certifications, and Clearances: CPC Designation preferred. Registered reputed company (RN) reputed company licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and reputed company employees working on an out-of-state NLC license who reputed company change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure reputed company that state. reputed company is an Equal Opportunity Employer/Disability/Veteran Apply tot his job Apply tot his job Apply tot his job Apply To this Job