QHP Auditor (AHA)

A company is looking for a QHP Auditor (AHA) to perform medical record reviews and coding quality assessments for Qualified Health Plan projects.

Key Responsibilities

Conduct detailed chart reviews and code abstraction for accurate ICD-10-CM code assignment

Perform coding quality audits to ensure compliance with federal, state, and CMS documentation requirements

Support RADV audit initiatives by validating data accuracy and regulatory compliance

Required Qualifications

Active AHIMA or AAPC credential (RHIT, CCS, CCS-P, CPC, CIC, etc.); CRC certification preferred

RADV experience is required

Minimum of 7 years of medical coding experience, including 5 years in Risk Adjustment coding

Completion of an accredited medical coding program with current credentials

Proficiency in Microsoft Office tools and general technical aptitude