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Risk Adjustment Auditor I

Company: Florida Health Care Plans, Inc.
Location: Ormond Beach
Posted on: June 12, 2021

Job Description:


The Risk Adjustment Auditor will utilize their knowledge of professional coding to audit providers' diagnostic and procedural medical documentation to ensure accuracy and capture of correct codes within the EHR, Claims and Risk Adjustment applications. Establish and maintain ongoing relationships with Staff and Network Providers concerning correct documentation and coding. Act in a consultative manner on coding questions for providers and FHCP employees.


Education, skills and experience:

Certified Coder (CPC, CCS, CCS-P) or RHIT/RHIA with minimum two (2) years' recent, hands on coding and auditing experience required - preferably with an emphasis on Medicare requirements.
Minimum one (1) year experience with CMS Risk Adjustment preferred.
Substantial knowledge of Medical Terminology, ICD-10, CPT, HCPCS Coding and Medical Record Documentation, required.
Substantial knowledge of current Medicare coverage criteria as it relates to coding issues and procedures preferred.
Knowledge of the CMS Correct Coding Initiative (CCI) preferred.
Knowledge of Managed Care Services, data reporting, regulations, rules and guidelines at both the state and Federal levels preferred.
Ability to effectively communicate Medical Coding Documentation rules and regulations to Providers and/or staff, and coworkers.
Must demonstrate ability to communicate effectively and in a timely manner with Supervisor and FHCP employees and providers both orally and in writing concerning areas of responsibility.
Excellent organizational, analytical, verbal and written communication skills required.
Strong computer skills including Microsoft Word, Microsoft Outlook, & Excel.
Must be able to work well and interact with others in a positive & professional manner when under stressful situations; maintain confidentiality within the work environment.
Self-starter with ability to complete responsibilities independently with little supervision.
Must be a team player.
Medical Office, Managed Care Claims environment experience a plus.
Ability to maintain flexible work schedule to meet departmental needs required.
Must have a valid Florida driver's license and reliable transportation.

Keywords: Florida Health Care Plans, Inc., Palm Coast , Risk Adjustment Auditor I, Other , Ormond Beach, Florida

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