Quality Coding Auditor

About the role:

To be fully engaged in providing Superior Quality, Memorable Client and Vendor Experiences by effectively monitoring overall Risk Adjustment.  The individual will provide superior quality by performing audits pertaining to risk adjustment coding efforts.  The individual will be responsible for daily operations pertaining to auditing functions as assigned.    The individual will provide superior customer experience by educating internally and externally on opportunities for improvement discovered during auditing.  This individual will work closely with Management to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs.

Who you are:

• Maintain a quality assurance program 

• Play a key role in ensuring coding compliance and accuracy

• Monitor the performance of the Risk Adjustment Operations both internally and with coding vendors

• Provides expertise as it relates to coding compliance for new and existing services, while ensuring compliance with organizational, federal, state, and third-party requirements.

• Assist in the methods to effectively communicate information through presentations, reports, educational programs, memoranda, etc. by providing formal and informal education to QA specialists, coding vendors and staff.

• Report findings to Leadership in a timely, consistent and effective manner ensuring that appropriate changes are implemented.  

• Support audit processes ensuring work flows and results are properly documented and maintained.  Identify process improvements as needed.  

• Assist in the development of an effective training program regarding correct coding techniques/practices

• Assist with training new auditors and training of other staff as needed.  

• Create methods to share information on the program, quality, and initiatives with Apixio Management on a monthly cadence at minimum.

• Perform other duties as assigned

What you bring to the table:

• Bachelor’s degree in a relevant field of study preferred, or 3-5 years of related work experience as a coder, with a minimum of 5 years of coding experience in risk adjustment for both ACA and MA; CRC, CPC, or CCS certification preferred.

• Expert knowledge of Risk Adjustment . 

• Research and problem resolution skills.

• Exceptional interpersonal relationship skills.

• Must possess strong managerial, financial, and analytical skills.

• Consistent demonstration of commitment to quality, customer focus, productivity, and process improvement.

• Strong communication skills to effectively interact all levels of the organization, business unit leaders, and staff in a tactful and positive manner.

• Experience overseeing remote (Work at Home) operations.

• Exceptional interpersonal skills, proven success in complex and ambiguous environments.

• Ability to work independently, with high productivity, and regularly meet deadlines.

• Demonstrates excellent written and verbal communication skills conforming to all rules of punctuation, grammar, diction and professional style.

• Experience in initiating, developing and monitoring policies, internal control procedures and operating standards.