Senior Risk Adjustment Auditor - Health Plan

Careers With Purpose

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.

Facility: Remote SD (Central Time)

Location: Remote, SD

Address:

Shift: Day

Job Schedule: Full time

Weekly

Hours:

40.00

Salary Range: $31.00 - $49.50

The Senior Risk Adjustment Auditor must have broad clinical knowledge and a strong understanding of Risk Adjustment operations, including experience coding for both the ACA and Medicare Advantage markets. This position will be responsible for overall outcomes and daily activities supporting Risk Adjustment Data Validation (RADV) audits, targeted quality assurance audits, , vendor quality assurance oversight, internal coding team quality assurance, provider and clinical staff education, and other risk adjustment projects.

Applies expertise in HCC documentation, audit rules, , risk adjustment operations, and general clinical knowledge to increase the accuracy and completeness of our initiatives, including Risk Adjustment Data Validation (RADV) audits, retrospective and prospective audits, vendor quality assurance reviews, and provider and clinical staff education. Is accountable for the successful development, implementation and delivery of educational and training resource materials to assist providers in coding accuracy.

Will work independently the majority of the time with a high degree of autonomy. This position will collaborate with department analyst(s) on relevant data operations.

• Associate required, Bachelor’s preferred.
• Minimum of 5 years HCC coding and auditing for Risk Adjustment required. Required experience with: intermediate understanding of RADV protocols and procedures; intermediate understanding of retrospective and prospective risk adjustment;
  Basic familiarity with Microsoft suite, including excel.
• Working Knowledge of Epic or similar HER preferred. Experience discussing HCC coding and clinical details with all provider types with strong Knowledge of CMS HCC model, hierarchy, and relative HCC values required.
• Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or relevant equivalent is required
• Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state (preferred.) Obtains and subsequently maintains required department specific competencies and certifications.

Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit  .

• health insurance
• dental insurance
• vision insurance
• life insurance
• a 401(k) retirement plan
• work/life balance benefits
• a generous time off package

Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call or send an email to talent .

Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Req Number: R-0273979

Job Function: Health Plan

Featured: No