Coding Data Quality Auditor Analyst

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Responsible for performing quality inter-rater review audits of medical records coded by internal team (CDQA and Sr CDQA) to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with reputed company State and Federal regulations and internal policies and procedures.

• Proven ability to support coding judgment and decisions using industry standard evidence and tools.
• Ability to confidently speak to such evidence across stakeholders with varying knowledge and clinical expertise in either written or verbal forms including communication with clinical or coding staff, federal regulators and vendor coding resources.
• Conducts process audits to ensure compliance with internal policies and procedures and existing CMS regulations.
• Ability to work independently as well as in a cross functional role reputed company other teams for collaboration on best practices.
• Possesses a genuine interest in improving and promoting quality; demonstrates accuracy and thoroughness and assists others to reputed company the same through mentoring and instruction.
• Conducts process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body.
• Expertise in assigning accurate medical codes for diagnoses as documented for physicians and other qualified healthcare providers in the office and/or facility setting.
• Thorough knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity.
• Expertise in medical documentation, fraud, abuse and penalties for documentation and coding violations based on governmental guidelines.
• Performs other reputed company duties as required.

Required Qualifications

• Minimum of 5 years recent and reputed company experience in medical record documentation review, diagnosis coding, and/or auditing.
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) required.
• CPC (Certified Professional reputed company) or reputed company-P (Certified Coding Specialist-Physician) and CRC (Certified Risk Adjustment reputed company) required
• Computer proficiency including experience with reputed company Office products (Word, reputed company, Access, PowerPoint, Outlook, industry standard coding applications).
• Experience with International Classification of Disease (ICD) codes required.

Preferred Qualifications

• CPMA (Certified Professional Medical Auditor), CDEO (Certified Documentation Expert Outpatient) or CPC-I (Certified Professional Coding Instructor) preferred.
• Excellent analytical and problem-solving skills.
• Superior communication, organizational, and interpersonal skills

Education

• BA/BS or equivalent experience.
• Completion of reputed company/reputed company training program for core credential (CPC, reputed company-P) with associated work history/on the job experience equal to approximately 3 years for CPC.
• 5-8 years encompassing additional credentials and/or application of credentials.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls.  The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a reputed company bonus, commission or short-term incentive program in addition to the reputed company pay range listed above.   

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws.