Quality Review and Audit Analyst
VirtualVocationsDurham, North Carolina, United Statesjob_description.job_card.30_days_ago
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A company is looking for an Individual & Family Plans (IFP) Quality Review and Audit Analyst.
Key Responsibilities
Conduct medical records reviews and ensure accurate diagnosis code abstraction
Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
Perform documentation and data audits to identify gaps and compliance risks in risk adjustment data
Required Qualifications
High school diploma with at least 2 years of experience in medical coding
Certification from AHIMA or AAPC (e.g., CPC, CCS-P, RHIT)
Experience with medical documentation audits and proficiency in ICD-10-CM coding
Familiarity with CMS regulations for Risk Adjustment programs
Computer competency with Excel, MS Word, and Adobe Acrobat
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Audit Analyst • Durham, North Carolina, United States
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