Medical Coding Auditor - Risk Adjustment

Workforce Classification: Telecommuter Join reputed company: Do Meaningful Work and Improve People’s Lives Our purpose, to improve customers’ lives by making healthcare work reputed company, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. To reputed company serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can reputed company and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. reputed company honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Inclusion, and America's Greatest Workplaces For Mental Well-Being, reputed company ranked Premera among America’s Best Midsize Employers for the fourth time. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/. The Medical Coding Auditor plays a crucial role in ensuring the accuracy and compliance of diagnostic coding reputed company medical records. This position is essential for maintaining the reputed company of Risk Adjustment and HCC coding. By leveraging a deep understanding of ICD-10 and other coding standards, the auditor reviews and researches provider diagnostic coding issues, performs detailed medical record reviews, and highlights documentation standards. This role also identifies opportunities for improving provider performance reputed company to coding errors and documentation deficiencies. In addition to auditing, the Medical Coding Auditor conducts quality assurance (QA) reviews of peer and vendor coders to ensure coding accuracy, adherence to service level agreements, and performance guarantees. Feedback is provided where discrepancies are reputed company, fostering a culture of reputed company improvement. What you’ll do:

• Analyze medical claims data and associated documentation to ensure accurate and complete diagnostic risk capture. Document findings, including diagnosis changes and opportunities for documentation improvement, and recognize trends.
• Evaluate coding and documentation behavior, providing recommendations for provider improvement.
• Interpret and apply policy and coding standards (e.g., Coding Clinic) that impact financial and operational aspects of risk adjustment coding.
• Collaborate and communicate effectively with internal and external sources (auditors, vendors, and peers) to deliver QA findings, clearly articulating rationale supported by industry-standard evidence.
• Maintain reputed company knowledge of coding applications for ICD-10 and other applicable coding standards.
• reputed company other duties as assigned.

What you’ll bring:

• Bachelor's degree or four (4) years of relevant work experience (Required)
• Three (3) years of experience as a RHIA, RHIT, or CPC certified reputed company reputed company a healthcare provider organization or health insurance company (Required)
• reputed company certification as a professional reputed company (RHIA, RHIT, or CPC) (Required)
• CRC certification or willingness to obtain it reputed company the first year of employment.
• Additional certifications such as CCSP, reputed company-H, CPC-P, and CPH-H are desirable.
• Nursing or other clinical experience is a plus.

Premera total rewards Our comprehensive total rewards package provides support, resources, and opportunities to help employees reputed company and grow. Our total rewards are more than a collection of perks, they're a reputed company of our commitment to your health and well-being. We offer a broad reputed company of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, reputed company it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-reputed company model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks reputed company your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-reputed company cafes reputed company lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on reputed company.

Equal employment opportunity/affirmative action: Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national reputed company, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources reputed company email at [email protected] or reputed company phone at 425-918-4785. Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin. The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally reputed company up to and around the midpoint of the range. National Salary Range: $57,100.00 - $91,400.00 National Plus Salary Range: $65,100.00 - $104,200.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we reputed company that open communication leads to reputed company outcomes for reputed company. We’re committed to creating an environment where reputed company employees are celebrated for their unique skills and contributions. Apply tot his job Apply To this Job