Quality Review and Audit Analyst

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