Quality Review and Audit Analyst – Remote

Responsibilities: Conduct medical record reviews and diagnosis code abstraction to ensure compliance with coding guidelines and HHS Risk Adjustment models. Identify data gaps and compliance risks while collaborating with partners to improve internal program processes and education.

Requirements: Requires a high school diploma and at least 2 years of experience with a recognized coding certification (CPC, CCS-P, CCS-H, RHIT, RHIA, or CRC). Proficiency in ICD-10-CM guidelines and familiarity with CMS Risk Adjustment regulations are essential.

Key skills: Medical Coding, Risk Adjustment, ICD-10-CM, HCC Coding, Medical Record Review, Compliance Auditing, Data Analysis, Microsoft Excel, Microsoft Word, Adobe Acrobat, Medical Documentation Audit, CMS Regulations, Quality Improvement, Diagnosis Code Abstraction, Longitudinal Data Analysis, Communication

Keywords: Risk Adjustment, HCC, ICD-10-CM, Medical Coding, CMS, HHS, RADV Audit, CPC, CCS-P, CCS-H, RHIT, RHIA, CRC, Medical Documentation, Compliance, Quality Review, Data Validation, Cigna Healthcare, Healthcare Audit, Medical Records