Risk Adjustment Auditor II

Risk Adjustment Auditor II

Work from home within Oregon, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of Risk Adjustment Auditors is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Auditors perform Retrospective/Prospective chart reviews both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting. They also Identify trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies – all in service of making our members’ health journeys easier.  

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:  

Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required. RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.  

Skills and Attributes: 

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.

• Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.

• Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.

• Demonstrated ability to identify and communicate trends in provider coding and documentation.

• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.

• Effective verbal and written communication skills.

• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.

• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.

• Demonstrated ability to provide proactive and creative solutions to business problems.

What You Will Do at Cambia:  

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.

• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.

• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.

• Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.

• Supports and actively participates in process and quality improvement initiatives.

• Maintains knowledge of relevant regulatory mandates …