Risk Adjustment Audit Senior Analyst

A company is looking for a Quality Review and Audit Senior Analyst for Individual & Family Plans (IFP), focusing on Risk Adjustment Data Validation (RADV) audits.

Key Responsibilities

Coordinate daily operations for IFP RADV audits and support Supplemental Diagnosis programs

Communicate and report daily productivity and risks associated with audits

Engage in Continuous Quality Improvement (CQI) of IFP programs and liaise with external partners

Required Qualifications

High School Diploma

At least five years of Risk Adjustment experience with relevant certifications (e.g., CPC, CCS-P, RHIT)

Certified Risk Adjustment Coder (CRC) certification within 12 months of hire

Experience with medical audits and proficiency in ICD-10-CM coding

Familiarity with CMS regulations and policies related to documentation and coding