Risk Adjustment Auditor and Physician Educator

Job Description

The Risk Adjustment Auditor and Physician Educator is responsible for developing the process and reporting for performing annual, period, and other quality assurance reviews of medical record documentation and coding to ensure appropriate capture of Hierarchical Condition Categories (HCC) conditions. This position utilizes expertise and national coding guidelines as reference in performing medical record coding audits and in partnership with the Physician Champion, develops strategies for provider education and training.

Qualifications

Prerequisites

1. Bachelor's degree in health sciences, health management or related field or equivalent related health experience required. 
2. Minimum 3 years of experience in risk adjustment coding and medical record review.
3. Minimum 3 years of experience delivering education and training to Physicians required. 
4. Certified Professional Coder (CPC) or Certified Coding Specialist-Physician Based (CCS-P) certification required.
5. Certified Risk Adjustment Coder (CRC) required.
6. Certified Professional Medical Auditor (CPMA) strongly preferred. 
7. Proficient in various computer applications, including Microsoft Office, Excel, Word, PowerPoint, Visio, and Outlook.

General Qualifications

1. In depth clinical understanding of chronic disease management.
2. Demonstrated proficiency in Medicare Risk Adjustment methodologies and ICD-10 coding concepts.
3. Experience in health systems operations including knowledge of value-based methodologies, payer reimbursement and coding conventions.
4. Demonstrated continuous learning in clinical medicine; practical understanding of ICD-10-CM/PCS and ability to educate physicians on the merits of best practice documentation strategies.
5. Demonstrated ability to interpret national documentation and coding guidelines and translation to effective auditing practices and tools. 
6. Demonstrated ability to identify issues in documentation and coding practices and develop plan to remediate.
7. Demonstrated ability to meet deadlines, with good time management and prioritization skills.
8. Self-motivated and able to work independently.
9. Demonstrated ability for critical thinking skills, with focus on assessment, evaluation, and teaching.
10. Strong organization and analytical thinking skills; detail oriented.
11. Strong verbal, written and presentation skills.

Additional Information

Build your future with Valley Medical Center & Clinics! Join a team that values its people and offers excellent benefits and opportunities to grow.

• Medical, dental, and vision insurance
• Retirement plan with employer contributions
• Generous paid time off, including vacation, sick leave, and holidays
• Life and disability insurance
• Flexible spending accounts
• Employee wellness and assistance programs

Equal Employment Opportunity

Valley Medical Center & Clinics is committed to equal employment opportunity (EEO) and nondiscrimination in all aspects of employment and participation in its programs. 

We do not provide sponsorship opportunities at this time.

• Valley Medical Center & Clinics participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Compensation: 86267 to 129401 (USD) (YEARLY)