Risk Adjustment Quality Analyst

A company is looking for an Individual & Family Plans (IFP) Quality Review and Audit Analyst.

Key Responsibilities

Conduct medical records reviews and accurate diagnosis code abstraction following relevant coding guidelines

Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC) from ICD-10-CM codes

Perform documentation and data audits to identify gaps in risk adjustment data and compliance risks

Required Qualifications

High school diploma and at least 2 years of experience with relevant coding certifications (e.g., CPC, CCS-P, RHIT)

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

Familiarity with CMS regulations for Risk Adjustment programs

Computer competency with Excel, MS Word, and Adobe Acrobat

Understanding of medical claims submissions is preferred