CareOregon, Inc. is hiring a Senior Risk Adjustment Coding Auditor to serve as a subject matter expert on coding practices. In this role, you will perform and lead audits, review medical records for accurate diagnosis code capture, and develop training and process documentation for providers and internal stakeholders.
What You'll Do
- Perform and lead a variety of coding-related audits for providers and other entities.
- Review medical records to verify complete and accurate diagnosis codes are captured in claims and retrospective chart review data.
- Communicate audit results and recommendations for improvement to providers.
- Create and maintain processes for tracking audit results and outcomes of reviews.
- Identify, track, analyze, and report on trends revealed in audits.
- Develop and maintain centralized policy, process, and compliance-related documentation and training resources.
- Lead the development of educational materials and process documentation in various mediums.
- Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations.
- Maintain active coding certification and seek out emerging coding best practices.
- Serve as a subject matter expert regarding correct coding practices.
- Work with the Risk Adjustment team to create Standard Operating Procedures (SOPs), process flows, and contribute to roadmaps.
- Onboard and train new Coding Auditors, overseeing and auditing their results with feedback and retraining.
- Lead Risk Adjustment Data Validation (RADV) and other diagnosis code related audits for the Finance department.
- Perform Retrospective and Concurrent chart reviews to ensure accurate risk adjustment reporting.
- Verify and ensure the accuracy, completeness, specificity, and appropriateness of provider-reported diagnosis codes.
- Review medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
- Serve as a risk adjustment coding resource, offering expert guidance on coding and compliance questions.
What We're Looking For
- Minimum 5 years’ experience as a certified coder.
- Current coding certification from AHIMA or AAPC.
- One-year experience with a risk adjustment program in a Health Plan (applies to roles in Finance/Risk Adjustment department).
Nice to Have
- Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP), or Certified Documentation Expert Inpatient/Outpatient (CDEI/CDEO).
- Experience leading group educational presentations and teaching to medical professionals.
- 5 years’ experience with CMS, HHS, and/or CDPS+RX Hierarchical Condition Categories (HCC) models (applies to roles in Finance/Risk Adjustment department).
- Experience with or knowledge of risk adjustment principles (applies to roles in Finance/Risk Adjustment department).
Technical Stack
- Microsoft Office (PowerPoint, Excel, Word)
- SAS
- SQL
- Tableau or other analytic software (helpful, but not required)
- Electronic health record (EHR) software systems
Team & Environment
This role applies to the Finance (Risk Adjustment) Department at CareOregon.
Benefits & Compensation
- Compensation range: $81,000.00 - $99,000.00
- Medical, dental, vision, life, AD&D, and disability insurance
- Health savings account, flexible spending account(s), lifestyle spending account
- Employee assistance and wellness programs
- Discounts and multiple supplemental benefits (voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.)
- Strong retirement plan with employer contributions
- PTO, Paid State Sick Time, paid holidays, volunteer time, jury duty, and bereavement leave
Work Mode
This is a hybrid position with a work-from-home component.
CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability.
