Auditor, Risk Adjustment (Remote)

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

Job summary

A healthcare organization in Tampa, Florida, is seeking a qualified professional for risk adjustment data validation. The role involves daily operations management, audit support, and compliance with CMS regulations. Candidates must have 3 years of experience in coding and medical record chart review along with an active coding certification. Competitive compensation is offered, with a pay range of $77,969 - $128,519 annually.

Benefits

Competitive benefits and compensation package

Qualifications

• 3 years in coding and medical record chart review with risk adjustment experience.
• Active and unrestricted Coding Certification (CCS, CCS-P, or CPC).

Responsibilities

• Assist in daily operations of risk adjustment data validation.
• Support risk adjustment audit projects and ensure deliverables are met.
• Evaluate audit results and implement corrective action plans.
• Act as an audit liaison with various stakeholders.
• Develop processes for compliance with CMS regulations.
• Oversee data transmission and integrity.
• Perform monthly audits on coding specialists and external vendors.

Skills

Data validation

Risk assessment

Audit processes

Data integrity

Medical coding

Education

Associates degree

Bachelor's Degree in Business Administration or Health Care Management

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 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

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.