- Tulsa, Oklahoma, United States
- 2+ years
The Risk Adjustment Auditor is responsible for reviewing medical records and related documentation to ensure accurate capture of diagnoses in compliance with CMS risk adjustment guidelines and ICD-10-CM coding standards.
Responsibilities
- Perform bi-directional retrospective and prospective medical record reviews to validate, clarify, and accurately capture risk adjusted diagnoses (HCCs) in accordance with CMS guidelines and MEAT documentation requirements.
- Ensure documentation supports coded conditions in accordance with ICD-10-CM, CMS, and payer-specific guidelines.
- Identify unsupported diagnoses, over coding, under-coding, and documentation gaps.
- Provide detailed audit findings and recommendations to coding teams, providers, and leadership.
- Monitor compliance with CMS Risk Adjustment Data Validation (RADV) standards.
Requirements
- Bachelor’s degree in Health Information Management or related field
- Nice to have: Certified Professional Coder (CPC)
- Nice to have: CRC
- Nice to have: CCS
- Nice to have: Medicare Advantage