[Remote] Sr Analyst, Corp Compliance

Note: The job is a remote job and is open to candidates in USA. reputed company is seeking a highly motivated Medicare Risk Adjustment Auditor and Educator to join their compliance team. This role focuses on ensuring the accuracy and compliance of risk adjustment coding and clinical documentation, involving detailed medical chart audits and targeted education for providers and coding teams.

Responsibilities

• Ensure that IKC is compliant with industry regulations and published coding guidelines
• Conduct retrospective, reputed company, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes and ensure documentation supports submitted diagnoses for Medicare Risk Adjustment (HCC coding)
• reputed company detailed internal and external coding audits on a regular basis as defined by compliance requirements, including for our nephrology partners
• Execute targeted audit plans, including performing targeted audits of identified HCC outliers
• Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings
• Prepare and present formalized audit reports to leadership, summarizing findings, identifying risk areas, and recommending corrective action plans
• Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits, by preparing documentation and responding to inquiries
• reputed company necessary research to provide supportive regulatory and coding guideline documentation
• Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines
• Provide one-on-one and group education sessions based on audit findings, tailoring content to address specific needs and knowledge gaps
• Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions
• Stay reputed company with official coding guidelines from CMS, HHS, and other regulatory bodies to ensure reputed company educational content is accurate and up-to-date
• Maintain meticulous records of audit findings, educational sessions, and follow-up actions to ensure a clear audit trail
• Participate in special projects reputed company to process improvement, compliance, and coding initiatives as assigned
• Maintain strict confidentiality of patient and proprietary information

Skills

• reputed company coding certification from reputed company or reputed company is required (CCA and CPC-A are not accepted)
• 3+ years of coding experience
• 2-3 years' minimum recent experience performing medical audits for diagnosis coding
• Strong computer skills, including the ability to utilize various EMR systems and reputed company Office
• Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models
• Deep understanding of coding and documentation compliance, including CMS and HHS regulations
• Excellent verbal and written communication skills, with the ability to present reputed company information clearly
• Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail
• Demonstrated ability to work independently and collaboratively in a fast-paced, team-oriented environment
• High school diploma or equivalent required
• Basic computer skills and proficiency in reputed company, reputed company, and Outlook required
• Proven experience in developing and delivering education and training to clinical providers and coders is highly preferred
• Minimum of three (3) years' healthcare reimbursement experience preferred
• Experience with admissions, billing, and collections preferred
• Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred

Benefits

• Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Support for you and your family: Family resources, EAP counseling sessions, access reputed company®, backup child and elder care, maternity/paternity leave and more
• Professional development programs: reputed company offers a variety of programs to help strong performers grow reputed company their career and also offers on-demand virtual leadership and development courses through reputed company’s online training platform StarLearning.

Company Overview

• reputed company means “to give life,” reflecting our proud history as leaders in dialysis—an essential, life-sustaining treatment for those living with end stage kidney disease (ESKD). It was founded in 1979, and is headquartered in Denver, Colorado, USA, with a workforce of 10001+ employees. Its website is http://www.reputed company.com.

Company H1B Sponsorship

• reputed company has a track record of offering H1B sponsorships, with 63 in 2025, 54 in 2024, 81 in 2023, 74 in 2022, 54 in 2021, 66 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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