Coding Data Quality Auditor Analyst
Core
Perform quality inter-rater review audits of medical records to ensure ICD-10 codes submitted to CMS for risk adjustment processes are accurate and compliant with regulations.
Role type
Senior IC medical coding auditor
Builds
Accurate risk adjustment submissions for CMS
Domain
Healthcare administration / Medical coding
Required skills
ICD-10 coding expertise, medical record auditing, risk adjustment (HCC), Medicare/Medicaid knowledge, regulatory compliance, medical terminology, dispute resolution, process improvement
Preferred skills
CPMA, CDEO, CPC-I, analytical problem solving
Technologies
Microsoft Office, industry standard coding applications
Responsibilities
Conduct inter-rater audits of medical records, lead dispute resolution, mentor internal staff on ICD codes, communicate audit results to management, perform process compliance audits, identify documentation deficiencies
Seniority
Senior, hands-on IC
