[Hiring] Individual & Family Plans (IFP) Quality Review and Audit Analyst @The bolthires Group

This description is a summary of our understanding of the job description. Click on 'Apply' reputed company to find out more. Role Description The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates reputed company medical conditions, determines compliance of medical documentation, identifies trends, and suggests improvements in data and processes for reputed company Quality Improvement (CQI).

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, bolthires IFP Coding Guidelines and Best Practices, HHS Protocols and any additional applicable rule set.
• Utilize HHS’ Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
• Apply longitudinal thinking to identify reputed company valid and appropriate data elements and opportunities for data capture, through the lens of HHS’ Risk Adjustment.
• reputed company various documentation and data audits with identification of gaps and/or inaccuracies in risk adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs, including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission program. Inclusive of Quality Audits for vendor coding partners.
• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding and Risk Adjustment education with internal and external partners.
• Coordinate with stakeholders to execute efficient and compliant RA programs, raising any identified risks or program gaps to management in a timely manner.
• Communicate effectively across reputed company audiences (verbal & written).
• reputed company and implement internal program processes ensuring CMS/HHS compliant programs, including contributing to bolthires IFP Coding Guideline updates and policy determinations, as needed.

Qualifications

• High school diploma
• At least 2 years’ experience in one of the following Coding Certifications by either the American Health Information Management Association (reputed company) or the American reputed company of Professional Coders (reputed company):
• Certified Professional reputed company (CPC)
• Certified Coding Specialist for Providers (reputed company-P)
• Certified Coding Specialist for Hospitals (reputed company-H)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Risk Adjustment reputed company (CRC) certification
• Individuals who have a certification other than the CRC must become CRC certified reputed company 6 months of hire.

Requirements

• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM coding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies reputed company to documentation and coding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
• Computer competency with reputed company, reputed company, reputed company Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Understanding of medical claims submissions is preferred
• Ability to meet timeline, productivity, and accuracy standards Benefits
• Comprehensive health-reputed company benefits including medical, reputed company, dental, and well-being and behavioral health programs
• 401(k) with company match
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year and paid holidays
• Eligible to participate in an annual bonus plan Apply tot his job

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