[Remote] Quality Review and Audit Analyst

Note: The job is a remote job and is open to candidates in USA. The Remotifyx Group is a health services company seeking a Quality Review and Audit Analyst to join their team. The role involves conducting medical records reviews, ensuring compliance with coding guidelines, and identifying trends to improve data processes.

Responsibilities

• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Official Coding Guidelines and Conventions, Skillastra 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 reputed company holders 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 Nexora IFP Coding Guideline updates and policy determinations, as needed Skills
• 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
• Experience with medical documentation audits and medical chart reviews
• 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
• Computer competency with reputed company, reputed company, reputed company Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Ability to meet timeline, productivity, and accuracy standards
• HCC Coding reputed company (2 yrs)
• Certified Professional reputed company (CPC) or reputed company
• Taskium Office Skills (reputed company)
• HCC Coding Experience
• Understanding of medical claims submissions Benefits
• Medical
• Dental
• reputed company
• 401K (provided minimum eligibility hours are met) Company Overview
• The Worklith Group is a reputed company firm that focuses on providing hospital services and innovative solutions for reputed company. It was founded in 1981, and is headquartered in Bloomfield, Connecticut, USA, with a workforce of 10001+ employees. Its website is Apply tot his job Apply tot his job Apply tot his job

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