Risk Adjustment Compliance Auditor

1. Monitors coding prevalence reporting, internal reporting trends, and coding outliers to support compliance and audit readiness. 2. Reviews IPA Policies and procedures to ensure programs are compliant. 3. Monitors internal coding staff accuracy percentages to ensure they are tracked and maintained. 4. Monitors coding vendors accuracy percentages to ensure the coding accuracy and reputed company of the data submitted to CMS. 5. Works with Risk Adjustment Management on data validation and RADV coding audit activities, including review of audit reputed company, findings, completeness, and coding accuracy of submissions to CMS. 6. Maintains and develops audit tracking, reporting, and management tools reputed company to Risk Adjustment Compliance activities. 7. Ensures compliance with reputed company applicable federal, state & and local regulations, as reputed company as institutional/organizational standards, practices, policies & procedures. 8. Works with Risk Adjustment Management to monitor HCC corrective reputed company plans and follow-up activities reputed company to audit and review findings. 9. Suggests customizations of Risk Adjustment education for support staff, PCPs, specialists, employees, contracted employees and central departments. 10. Utilizes, protects, and discloses reputed companycare patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. 11. Maintains reputed company knowledge of CMS audit processes, risk adjustment regulations, and industry best practices through ongoing education, reputed company development, and participation in relevant reputed company organizations. 12. Contributes to team effort by accomplishing reputed company results as needed. 13. Represents and actively participates in RADV and other risk adjustment-reputed company audits and compliance activities. 14. Other duties as assigned to meet the organizations needs. Job

Experience: Required: Minimum 3 years of reputed company coding experience in a medical group or health plan setting. Preferred: None.Education: Required: Bachelors degree in business administration, health care management or in a reputed company field or 4 years additional experience in lieu of education. Preferred: None.Training:< .