Remote Risk Adjustment Documentation and Coding Auditor

CSI Companies is hiring a  REMOTE Risk Adjustment Documentation and Coding Auditor

for our Fortune 100 healthcare client in  Palm Beach, Florida.

Employment Type : Contract-to-Hire

Pay : $40 - $45 per hour

Location : Remote (U.S. based candidates)

Job Overview :

The Risk Adjustment Documentation and Coding Auditor is responsible for supporting the Longevity Health Plan’s mission to improve the health and quality of life of nursing home residents. This role involves performing audits of medical record documentation and coding to ensure appropriate capture of CMS Hierarchical Condition Categories (HCC) conditions for Medicare Risk Adjustment reimbursement. The Auditor will leverage their expertise in coding guidelines and regulations to ensure compliance and make necessary recommendations for corrective actions. The position demands critical thinking and effective communication skills to drive change and ensure high standards in documentation and coding practices.

Job Duties :

• Perform documentation and coding audits using pre-designed templates to ensure accurate risk adjustment data is submitted to CMS.
• Use judgment and critical thinking to evaluate variances in documentation and coding, escalating issues to Risk Adjustment Management as needed.
• Recommend procedural or policy changes based on audit findings to address variances in coding and documentation practices.
• Develop and maintain audit tools, track audit results, and recommend corrective action plans.
• Monitor internal reporting for coding / CPT outliers, staying current with CMS audit processes and participating in related audits.
• Escalate trends from audits to the RA Manager and Director, providing suggestions for corrective actions.
• Translate national documentation and coding guidelines into practical auditing practices and review tools.
• Perform other duties assigned to support Risk Adjustment Program performance.

Requirements

Salary : $40 - $45