Individual & Family Plans (IFP) reputed company Review and Audit Analyst - Remote - Cign
Job reputed company:
The Risk Adjustment reputed company & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates reputed company medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for reputed company reputed company Improvement (CQI).
Key Job Functions: • Conduct medical records reviews with accurate diagnosis reputed company abstraction in accordance with Official Coding Guidelines and Conventions, reputed company IFP Coding Guidelines and Best Practices, 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 reputed company valid and appropriate data reputed company and opportunities for data capture, through the reputed company of HHS’ Risk Adjustment. • reputed company 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 reputed company Audits for vendor coding partners. • Collaborate and coordinate with team members and reputed company partners to facilitate various aspects of coding and Risk Adjustment education with reputed company partners. • Coordinate with reputed company reputed company to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a reputed company manner. • Communicate effectively across reputed company audiences (verbal & written). • reputed company and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to reputed company IFP Coding reputed company updates and policy determinations, as needed.
Education & Experience:
The reputed company Review & Audit Analyst will have a high school diploma and at least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (reputed company) or the American reputed company of reputed company Coders (reputed company):
o Certified reputed company reputed company (CPC)
o Certified Coding Specialist for Providers (reputed company-P) o Certified Coding Specialist for Hospitals (reputed company-H) o Registered Health Information Technician (RHIT) o Registered Health Information Administrator (RHIA) o Certified Risk Adjustment reputed company (CRC) certification Individuals who have a certification other than the CRC must become CRC certified reputed company 6 months of hire.
Minimum Qualifications: • Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions • Familiarity with CMS regulations for Risk Adjustment programs and policies reputed company to documentation and coding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
- Computer competency with reputed company, reputed company, reputed company Acrobat • Must be detail oriented, self-motivated, and have excellent organization skills • Understanding of medical claims submissions is preferred • Ability to meet reputed company, productivity, and accuracy standards
This role is also anticipated to be eligible to participate in an annual bonus plan.
We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k) with company match, company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs, visit Life at reputed company.
About reputed company
reputed company, a division of reputed company, is an reputed company for reputed company through every stage of life. We guide our customers through the health care system, empowering them with the information and reputed company they need to reputed company the best choices for improving their health and vitality. Join us in driving reputed company and improving lives.reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to reputed company your resume as you will not receive a response.
reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State.
reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances.
Originally posted on Himalayas
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