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Risk Adjustment Auditor

Risk Auditors | Franciscan Physician Network

 

Address  Work from home (within reasonable distance to Franciscan faciltities in Indiana or Illinois)

 

Calendar  Full-Time

 

Education Associate degree required for Nursing or Medical Assisting (MA certification will be accepted in lieu of degree)

 

Hours  Days

WHAT WE NEED

Risk Adjustment Auditor

WHO WE ARE LOOKING FOR

Our Risk Adjustment auditors review medical records to accurately identify diagnoses to ensure the accuracy, completeness, specificity and appropriateness of documentation and diagnosis codes based on pre-visit services to capture the health status of the patients we serve. It requires someone who has excellent communication skills and attention to detail. Think you're up for the challenge?

Can you help develop solutions designed to improve provider documentation? Can you manipulate data and develop reports? Do you want to work in an environment that values your skills and gives you a chance to grow them? If so – get ready to apply to your next job.

WHAT YOU WILL DO
  • Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries to verify and ensure the accuracy, completeness, specificity and appropriateness of diagnosis codes based on pre-visit services. 
  • Assist with validation audits, evaluate medical record documentation and ensure documentation accurately reflects and supports relevant coding.
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC. 
  • Follow-up with providers and track results.
  • Use the EPIC pre-encounter tool to record potential diagnosis codes prior to the visit. 
  • Review patient medical records on a pre-visit basis to ensure risk score accuracy. 
  • Develop solutions designed to improve provider documentation, accurately capture appropriate diagnosis codes and remove those that are inappropriate.
WHAT IT TAKES TO SUCCEED
  • Prior Risk Adjustment and/or Coding experience.
  • Attention to detail while reviewing patient’s clinical record.
  • An inquisitive attitude, willingness to learn and continually expand their knowledge base are also important. 
  • Ability to work on a computer for long hours while meeting deadlines for assigned coding and auditing projects.
  • Discern pieces of information and make a critical decision based on the information presented.
  • Maintain required levels of productions and quality standards as established by management. 
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC. 
  • Sound communication skills.
  • Knowledge of ICD-10 coding and CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.


 

WHAT WE'RE LOOKING FOR
 

 

3-5 Years coding experience preferred

RN, LPN or Medical Assistant experience. Licensure and certification in correlation to your educational background.

 


 

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity.

Work From Home, Any, US, 0

Full-Time
Never or Rarely
employmentType:  Full-Time
Days
Work From Home
Any
0
Any