The Risk Adjustment Auditor is responsible for auditing medical records and Medicare claims to ensure coding accuracy and compliance with CMS guidelines. This role involves reviewing diagnosis codes, verifying medical documentation, and identifying potential discrepancies. The auditor escalates issues for secondary review or, in some cases, may complete secondary review for other auditors to resolve issues. Through these activities, the position contributes to optimized risk adjustment outcomes and regulatory compliance.

Essential Job Duties and Responsibilities:

· Work through a designated work queue for an assigned HIOS (Health Insurance Oversight System) payer plan.

.  Assign proper diagnosis codes for all services as supported by qualified medical documentation.

· Validate diagnosis codes submitted by clients, ensuring accuracy and proper documentation support.

· Compare client codes against results of review and escalating mismatches or other issues within ·

   Assist with other projects or support fellow coders as assigned to manage workflow and maintain productivity.

Requirements:

· Relevant credential from AAPC or AHIMA; CMPA preferred but not required

· 5 years of medical coding experience; inpatient coding experience preferred but not required

· Must be able to pass Medicare IRR review with 95% accuracy immediately upon hire

· Ability to code and maintain Elevate quality standards and meet productivity standards as documented in Elevate’s Coding Compliance Plan as well as for each project.

· Ability to work in a performance-driven environment: a proactive, results-driven and goal-oriented approach

· Energetic, confident, self-starter with the ability to work independently and thrive in the dynamic environment of a growing company

· Technical skills required to learn and navigate a variety of software systems, trouble-shoot computer problems, install periodic software updates and work efficiently in a virtual environment.

· Ability to think/work independently while having positive interaction with a team.

· Excellent written and oral communication skills

· Advanced problem-solving skills

· Ability to maintain a strong attention to detail in review of lengthy and complex documents

Part-time/PRN up to 29 hours per week

Pay Range:  $24-$28 hr