Galaxy is hiring a Quality Review and Audit Senior Analyst – RADV to coordinate and implement daily processes for IFP Risk Adjustment programs. In this remote role, you will guide customers through the healthcare system and advocate for better health, ensuring compliant and efficient audit operations.
What You'll Do
- Oversee and coordinate daily operations for IFP Risk Adjustment Data Validation (RADV) audits.
- Support Supplemental Diagnosis programs as required.
- Liaise with the Initial Validation Audit Entity to ensure compliant, efficient, and successful audit processes, including file reconciliation and appeals.
- Coordinate with Quality Management to execute daily RA program operations.
- Participate in coding reviews of medical documentation for RA programs as needed.
- Communicate and report daily productivity and risks associated with IFP RADV audits and other RA programs.
- Collaborate with internal educational teams to develop curriculum ensuring compliance and program excellence.
- Contribute to IFP Coding Guideline updates and policy determinations.
- Liaise with Matrix Partners to develop and promote shared goals.
- Develop and implement internal program processes as required.
- Coordinate with Quality Management to determine priorities and demonstrate ability to prioritize projects to meet deadlines.
- Engage in Continuous Quality Improvement (CQI) of IFP programs.
- Work with external auditors to ensure compliant, efficient, and successful risk adjustment audits per CMS standards.
What We're Looking For
- High School Diploma.
- 5+ years of Risk Adjustment experience.
- Certification by either AHIMA or AAPC in one of the following: CPC, CCS-P, CCS-H, RHIT, RHIA.
- Certified Risk Adjustment Coder (CRC) certification (within 12 months of hire).
- Experience with medical audits.
- Proficiency with ICD-10-CM coding and guidelines.
- Familiarity with CMS regulations and policies related to documentation and coding, both with Inpatient and Outpatient documentation.
- Computer competency with Excel, MS Word, Adobe Acrobat.
- Must be detail oriented, self-motivated, and have excellent organization skills.
- For remote work: internet connection via cable broadband or fiber optic with speeds of at least 10Mbps download/5Mbps upload.
Nice to Have
- HCC coding experience.
- Risk Adjustment/CMS knowledge.
- Understanding of medical claims submissions.
Technical Stack
- Microsoft Outlook
- Microsoft Excel
- Microsoft Word
Team & Environment
Coordinates with Quality Management and liaises with Matrix Partners.
Benefits & Compensation
- Medical, vision, dental, and well-being and behavioral health programs.
- 401(k) with company match.
- Company paid life insurance.
- Tuition reimbursement.
- Minimum of 18 days of paid time off per year and paid holidays.
- Eligible to participate in an annual bonus plan.
- Annual salary range: $58,400 - $97,400 USD.
Work Mode
This is a fully remote position.
Galaxy is an equal opportunity employer. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth, sexual orientation, gender identity, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
