Address
Form of work What Is Your Impact?
Under the direction of the Sr. Manager ACA Risk Adjustment Audit, the Risk Adjustment Auditor III is responsible for performing medical record audits ensuring compliance with all applicable Federal and State regulations related to coding and documentation guidelines for Risk Adjustment. Codes, abstracts, and analyzes inpatient and/or outpatient medical records using International Classification of Diseases, Tenth Revision (ICD-10. Periodic travel up to 10% for quarterly onsite meetings.
The Key Responsibilities:
* Performs medical record validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
* Performs Risk Adjustment validation audits using external Electronic Medical Records (EMR) system access.
* Performs vendor quality audits to ensure accuracy and make corrections as needed.
* Supports CMS RADV targeted and/or National audit.
* Project work and/or additional work/duties as assigned.
Our Ideal Candidate
Our ideal candidate must currently reside in the state of Florida as they will be attending quarterly onsite meetings. They will have had their CPC (Certified Professional Coder) or CRC (Certified Risk Coder) (AAPC), and/or CCSP American Health information Management Association (AHIMA) for a minimum of 1 year. Experience in the ACA/Commercial Risk Adjustment Model is strongly preferred and experience with Medicare Risk Adjustment will also be considered.
What is REQUIRED:
* 1-year related work experience to include but is not limited to medical coding/auditing or equivalent combination of transferable experience and education
* Bachelor's degree or additional related equivalent work experience
* Proficient with ICD-10-CM Guidelines for coding and reporting
* Intermediate knowledge of medical terminology, abbreviations, body systems/anatomy, physiology, and concepts of disease processes
* Intermediate or higher level of Microsoft Office proficiency (Word, Excel, Outlook, PowerPoint)
Required Licenses and Certifications:
CPC (Certified Professional Coder) or CRC (Certified Risk Coder) (AAPC), and/or CCSP American Health information Management Association
(AHIMA) for a minimum of 1 year
What Is Preferred:
* Coding or auditing experience in a physician office/outpatient coding setting
* CMS HCC Risk Adjustment coding experience
* Experience working with regulatory agencies
What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
* Medical, dental, vision, life and global travel health insurance
* Income protection benefits: life insurance, Short- and long-term disability programs
* Leave programs to support personal circumstances
* Retirement Savings Plan includes employer contribution and employer match
* Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
* Additional voluntary benefits available and a comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
Salary Information:
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Typical Annualized Hiring Range: $57,200 - $71,500
Annualized Salary Range: $57,200 - $93,000
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.
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