Risk Adjustment Quality Analyst

Job Summary

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

Key Responsibilities

• Conduct medical records reviews and accurately abstract diagnosis codes following established guidelines
• Utilize HHS' Risk Adjustment Model to ensure accuracy of Hierarchical Condition Categories (HCC)
• Perform audits to identify gaps in risk adjustment data and collaborate with stakeholders to enhance compliance

Required Qualifications, Training, and Education

• High school diploma required
• At least 2 years of experience in medical coding with relevant certifications (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC)
• Ability to obtain CRC certification within 6 months of hire
• Experience with risk adjustment data validation and compliance audits preferred
• Familiarity with CMS/HHS compliance standards