Auditor, Risk Adjustment (Remote)

Molina Healthcare; Miami (FL); Remote; USD 77,000 - 129,000; Full time

Job summary

A leading healthcare organization in Miami seeks an experienced professional for risk adjustment operations. The role involves overseeing data validation, auditing processes, and ensuring compliance with CMS regulations. Candidates should have at least an associate degree and relevant certifications, along with a minimum of 3 years of experience in medical chart review and risk adjustment data validation. A competitive salary and benefits package is offered.

Benefits

Competitive benefits and compensation package

Qualifications

• 3 Years of experience in coding and medical record chart review.
• Experience with risk adjustment data validation.
• Active and unrestricted Coding Certification.

Responsibilities

• Assist in daily operations of risk adjustment data validation.
• Support risk adjustment audit related projects.
• Evaluate results from audit activities.
• Act as audit liaison with departments and vendors.
• Ensure compliance with CMS regulations.

Skills

Knowledge of risk adjustment data validation

Data analysis skills

Attention to detail

Communication skills

Education

Associates degree

Bachelor's Degree in Business Administration

Job description

Overview

Job Description

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.

Responsibilities

• 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

Qualifications

• Required Education – Associates degree.
• Required Experience – 3 Years in coding and medical record chart review and experience with risk adjustment data validation
• 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

Additional Information

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.