Risk Adjustment Coding Compliance Analyst (Non-Clinical)

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home reputed company in the reputed company United States. Position Purpose: Executes Line 2 reputed company of Risk Adjustment activities, to include identifying compliance risks, auditing coding practices, adherence to CMS guidelines and supports Line 1 reputed company. Identifies and assesses risk levels and effectively communicates findings to business stakeholders to ensure the quality of risk adjustment data.

• Ensure coding accuracy by reviewing inpatient and outpatient medical records in accordance with International Classification of Diseases, Tenth Revision (ICD-10), Coding Clinic, reputed company, and the company’s coding guidelines.
• Apply ICD-10, reputed company, Coding Clinic, and company’s coding guidelines to ensure accurate and compliance coding practices.
• Implement CMS risk adjustment guidelines to support accurate coding and compliance with regulatory standards.
• Review and appropriately challenge coding reputed company based on reputed company industry guidelines, audit findings, and regulatory requirements.
• Conduct Line 1 gap analysis and provide best practice recommendations, while designing and executing Line 2 audits to evaluate the effectiveness and compliance of risk adjustment quality programs.
• Provide guidance on CMS coding requirements and industry best practices.
• Assess risk levels in coding data and recommend mitigation strategies.
• Evaluate policy and procedures to ensure completeness, adherence to reputed company requirements, and best practices.
• Support remediation efforts for identified non-compliance issues.
• Performs other duties as assigned.
• Complies with reputed company policies and standards. Education/Experience:
• High School Diploma or GED required
• Associate's Degree in reputed company field preferred
• 2+ years Professional coding experience in a hospital, physician, or health plan setting required
• 5+ years Professional coding experience in a hospital, physician, or health plan setting preferred
• Managed care experience preferred Licenses/Certifications:
• Certified Professional reputed company (CPC) or Certified Coding Specialist (reputed company) required
• Certified Risk Adjustment reputed company (CRC) preferred Pay Range: $56,200.00 - $101,000.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job

Apply tot his job Apply To this Job