QHP Auditor

QHP Auditor (AHA)
We are seeking experienced medical coders with previous or current RADV (Risk Adjustment Data Validation) experience to assist with our Qualified Health Plan (QHP) project. The ideal candidate will ensure accurate coding and compliance with clinical documentation requirements.

This is a remote position.

1. Perform code abstraction and coding quality audits of medical records to ensure accurate assignment of ICD-10-CM codes, primarily for QHP (RADV).
2. Code government and state models, including various coding projects.
3. Maintain up-to-date knowledge of ICD-10-CM codes, CMS documentation requirements, and relevant state and federal regulations.
4. Achieve and maintain a minimum accuracy rate of 95% on all coding projects.
5. Assist with code abstraction and quality audits in accordance with Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and all applicable regulations and internal policies.

1. Current core coding credentials through AHIMA or AAPC (e.g., RHIT, CCS, CCS-P, CPC, CIC). AAPC CRC (Certified Risk Adjustment Coder) certification is highly recommended.
2. Mandatory RADV experience.
3. Strong organizational skills and attention to detail.
4. Proficiency in Microsoft Office (Outlook, Word, Excel) and other basic computer skills.
5. Excellent written and verbal communication skills.
6. Ability to work independently in a remote environment.
7. Access to a private, lockable office space to ensure the security of Member PHI.
8. Minimum of 7 years of coding experience, with at least 5 years specifically in Risk Adjustment coding.
9. Completion of an accredited medical coding program with current unencumbered credentials.
10. CPC Certification required.
11. 5 years of experience in Risk Adjustment coding.

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