Job Description

We are seeking a highly skilled and detail-oriented Medicare Advantage Risk Adjustment Auditor to support our client's risk adjustment initiatives. In this role, you will serve as a subject matter expert in ICD-10-CM coding and documentation guidelines related to chronic conditions. You will collaborate with physicians, IPA coders, and health plan risk adjustment teams to ensure the accuracy and compliance of diagnostic coding and documentation.

Key Responsibilities:

• Medical Record Audits: Conduct in-depth retrospective and prospective medical record audits for physicians (MD, DO, NP) to assess the accuracy of ICD-10-CM coding for chronic conditions and validate risk-adjustable diagnoses.
• Coding Pattern Analysis: Analyze trends and patterns in diagnosis coding across physician groups to identify potential gaps, risks, or areas for improvement.
• Provider Education: Develop and deliver tailored education sessions and materials to physicians and medical groups, focusing on best practices for clinical documentation and risk-adjustable coding.
• CMS RADV Support: Participate in CMS Risk Adjustment Data Validation (RADV) audits and other retrospective chart review initiatives as required.
• On-Site Collaboration: Travel to provider offices across the Los Angeles area a minimum of three days per week to conduct audits and provide real-time feedback and support.

Qualifications:

• A CRC (Certified Risk Adjustment Coder) certification is required .
• A CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification is required.
• 5+ years of experience in provider coding or billing is required.
• Experience with V24 and V28 risk adjustment models is required.
• Strong knowledge of RADV and audit processes.
• Strong technical skills in MS Office (Excel, PowerPoint, and Word).

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