Certified Coding Specialist Analyst

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

Key Responsibilities

Conduct medical records reviews and abstract diagnosis codes in compliance with relevant guidelines

Utilize HHS' Risk Adjustment Model to ensure accuracy of Hierarchical Condition Categories (HCC)

Perform audits to identify gaps in risk adjustment data and compliance risks for IFP programs

Required Qualifications

High school diploma

At least 2 years of experience in medical coding or related fields

Certification from AHIMA or AAPC (e.g., CPC, CCS-P, RHIT)

Ability to obtain Certified Risk Adjustment Coder (CRC) certification within 6 months of hire

Experience with compliance and quality audits in healthcare settings