QA Risk ADj Auditor II

Risk Adjustment Auditor I or II Hybrid role (3 days/week in office) at our Salt Lake City, Boise, Fargo, Portland, Vancouver, Renton, Medford, Burlington, Lewiston offices.

Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate. Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Every day, Cambia’s dedicated team of Risk Adjustment Auditors is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, the Risk Adjustment Auditor performs Retrospective/Prospective chart review utilizing various types of records to ensure accurate risk adjustment reporting. Responsibilities include assisting in second level reviews of all new HCCs identified through the first pass chart review process.

Identifies trends in provider coding/documentation and vendor risk adjustment reporting and makes those trends known to leadership as well as the coding team manager and training lead to develop intervention strategies – all in service of creating a person-focused health care experience.

Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.

Qualifications:

• Risk Adjustment Auditor I would have an Associate degree in Healthcare or related field and one year of experience in clinical coding or auditing or equivalent combination of education and experience. Risk Adjustment, HCC or Inpatient coding experience required.
• Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Risk Adjustment, HCC or Inpatient coding experience required.

Required Licenses, Certifications, Registration, Etc.:

• CPC and CRC coding certification required

Skills and Attributes:

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
• Demonstrated ability to perform quality audits of internal and vendor coding.
• Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.
• Demonstrated analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
• Demonstrated ability to identify and communicate trends in provider and vendor coding and documentation.
• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
• Effective verbal and written communication skills.
• Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired

Additional Skills and Attributes for Risk Adj Auditor II:

• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
• Demonstrated ability to provide proactive and creative solutions to business problems.

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
• Performs quality reviews of vendor coding in support of the risk adjustment process.
• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC and HHS HCC categories.
• Identifies trends in provider and vendor coding and documentation and partners with…