Auditor, Risk Adjustment (Remote)

Molina Healthcare; Garden City (ID); Remote; USD 77,000 - 129,000; Full time

Job summary

A leading healthcare provider in Garden City is seeking an experienced professional to manage risk adjustment data validation. The role includes daily operations support, auditing, and ensuring compliance with CMS regulations. Qualified candidates should have a minimum of 3 years of coding experience and hold an active regulatory certification. The position offers competitive compensation ranging from $77,969 to $128,519 annually.

Benefits

Competitive benefits and compensation package

Equal opportunity employer

Qualifications

• 3 Years in coding and medical record chart review and experience with risk adjustment data validation
• Active and unrestricted Coding Certification, Active CCS, CCS-P, or CPC credential

Responsibilities

• Assist in daily operations of risk adjustment data validation activities.
• Support risk adjustment audit projects to meet deliverables.
• Evaluate audit results for gaps and implement corrective actions.
• Act as audit liaison with departments and external vendors.
• Ensure compliance with CMS regulations in risk adjustment data.
• Oversee data transmission and resolve data issues.
• Identify data mining opportunities to minimize gaps.
• Ensure accuracy of risk adjustment payment in all markets.
• Perform monthly audits on internal and external coding specialists.

Skills

Risk adjustment data validation

Data integrity analysis

Audit liaison

Regulatory compliance

Education

Associates degree

Bachelor's Degree in Business Administration or Health Care Management

Tools

CMS guidelines

Job description

Overview

Develops, recommends and implements controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss.

Knowledge/Skills/Abilities

• Assist in the daily operations of all aspects of risk adjustment data validation related activities, including, but not limited to: progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines
• Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met
• Evaluate results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans as necessary
• Acts as an audit liaison with other departments, health plans, and external vendors
• Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data
• Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy
• Identify opportunities for data mining to ensure data gaps are minimized
• Apply best practices to ensure accuracy of risk adjustment payment in all markets
• Performs monthly audit on internal Molina Coding Specialists
• Audits external Molina Vendors.

Job Qualifications

Required Education

Associates degree.

Required Experience

3 Years in coding and medical record chart review and experience with risk adjustment data validation

Required Li

Required License, Certification, Association

Active and unrestricted Coding Certification, Active CCS, CCS-P, or CPC credential

Preferred Education

Bachelor's Degree in Business Administration, Health Care Management o

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $77,969 - $128,519 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.