Clinical Risk Adjustment Auditor

2 weeks ago


Phoenix, Arizona, United States American Healthcare Radiology Administrators Full time

Position Overview

As a Clinical Risk Adjustment Auditor, you will play a pivotal role in enhancing the quality of healthcare documentation and coding accuracy. This position is essential in ensuring that our healthcare providers meet the necessary coding standards and compliance regulations.

Key Responsibilities

  1. Conduct thorough reviews of medical records to assess documentation accuracy and ensure compliance with coding specificity requirements.
  2. Engage with healthcare providers to clarify and obtain additional documentation for any missing or ambiguous information.
  3. Analyze data trends in provider coding practices and recommend educational interventions to improve performance.
  4. Deliver comprehensive training sessions to healthcare providers and their staff on coding, billing, and documentation standards related to risk adjustment.
  5. Support concurrent coding efforts to achieve departmental objectives while maintaining a high quality audit accuracy rate.
  6. Perform various types of chart reviews, including prospective, concurrent, and retrospective, based on departmental needs.
  7. Assist in research and analysis related to compliance inquiries, coding issues, and documentation discrepancies.
  8. Maintain strict confidentiality in accordance with HIPAA regulations while conducting coding quality reviews.
  9. Stay updated on coding guidelines and federal regulations through continuous education and professional development.

Qualifications

The ideal candidate will possess a bachelor's degree in healthcare administration or a related field, or equivalent experience. A current credential such as Registered Health Information Administrator (RHIA), Registered Health Information Technologist (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) is required. A valid driver's license is also necessary for travel to various practices.

Experience in risk adjustment coding, along with a solid understanding of medical terminology, anatomy, and disease pathology, is essential. Strong interpersonal and instructional skills are necessary to effectively communicate and educate a diverse audience.

Proficiency in office software and healthcare applications is required, along with a commitment to maintaining high standards of accuracy and confidentiality in all aspects of the role.

Preferred Qualifications

Previous experience in training or customer service within a healthcare setting is advantageous. Additional credentials such as Certified Risk Adjustment Coder (CRC) are preferred.

This position offers a unique opportunity to contribute to the improvement of healthcare quality and compliance while working within a supportive and innovative environment.



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