Quality Auditor

Key Responsibilities

As a Quality Auditor Risk Adjustment Coding, your responsibilities will include:

• Conducting comprehensive audits on risk adjustment coding to ensure compliance with ICD-10-CM and HCC coding guidelines.
• Identifying coding errors, documentation deficiencies, and missed risk-adjusted conditions in medical records.
• Ensuring adherence to CMS Risk Adjustment guidelines and Medicare/Medicaid regulatory requirements.
• Providing detailed feedback and corrective actions to medical coders to improve coding accuracy.
• Reviewing and validating diagnosis coding to ensure proper risk adjustment factor (RAF) scores.
• Preparing quality audit reports and presenting findings to management and coding teams.
• Collaborating with coders, providers, and compliance teams to enhance documentation practices.
• Assisting in training sessions and workshops to improve coding quality and compliance.
• Staying updated on risk adjustment policies, payer guidelines, and regulatory changes in the healthcare industry.
• Maintaining strict HIPAA compliance and ensuring data confidentiality.

Required Skills & Qualifications

To be successful in this role, you should have:

• Certified Risk Adjustment Coder (CRC) Mandatory.
• Minimum 3 years of experience in Risk Adjustment Coding & Quality Auditing.
• Strong expertise in HCC Coding, ICD-10-CM, CPT, and HCPCS coding.
• Deep understanding of Medicare, Medicaid, and Commercial Risk Adjustment models.
• Experience with Electronic Medical Records (EMR) and EHR systems.
• Strong analytical skills to identify patterns, errors, and documentation gaps.
• Excellent communication skills to provide feedback and conduct coder training.
• Knowledge of HIPAA regulations and coding compliance standards.
• Proficiency in coding audit tools, risk adjustment score calculations, and error analysis.

What We Offer

We believe in fostering a positive and growth-oriented work environment. When you join us, you’ll enjoy:

• Competitive salary and performance-based incentives.
• Career growth opportunities in the RCM and medical coding industry.
• A supportive and collaborative work environment.
• Comprehensive health benefits (as per company policy)