Coding Auditor – Risk Adjustment

November 4

🥔 Idaho – Remote

Although this job is listed in Idaho, this company may be open to hiring remote in other states.

🌲 Oregon – Remote

Although this job is listed in Oregon, this company may be open to hiring remote in other states.

+3 more states

🥔 Idaho – Remote 🌲 Oregon – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🧀 Wisconsin – Remote

💵 $72.8k - $88.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

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CareOregon

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Healthcare Insurance • Non-profit

CareOregon is a community-focused health plan that provides coordinated physical, behavioral, dental and social-support services to Oregon Health Plan members, serving more than 500,000 people. The organization operates provider and member portals, offers care coordination, telehealth, language and tribal services, community grants and outreach, and programs addressing social determinants of health such as housing, nutrition and transportation.

501 - 1000 employees

Founded 1994

⚕️ Healthcare Insurance

🤝 Non-profit

📋 Description

• Perform and assist with a variety of coding-related audits for providers and other entities • Assist with RADV and other diagnosis code related audits (Applies to Finance department roles only) • Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data • Communicate audit results and recommendations for improvement to providers when needed • Create and maintain processes for tracking audit results and outcomes of reviews • Identify, track, analyze and report on any trends revealed in audits • Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders • Develop or assist with the development of educational materials and process documentation in a variety of mediums (e.g., recorded training sessions, reference documentation, etc.) • Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations by frequently referencing current ICD-10-CM and CMS manuals, reviewing professional publications, and attending educational workshops/conferences • Maintain active coding certification • Seek out emerging coding best practices using a variety of strategies (e.g., establishing personal networks, participating in professional associations, etc.) • Serve as subject matter expert regarding correct coding practices

🎯 Requirements

• Minimum 2 years’ experience as certified coder • Active coder certification through AHIMA or AAPC • For Finance Department only: Current Certified Risk Adjustment Coder (CRC) or completion within one year of hire • Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO) preferred • Experience leading group educational presentations and teaching to medical professionals preferred • Experience with or knowledge of risk adjustment principles (applies to roles in Finance/Risk Adjustment department) preferred

🏖️ Benefits

• Health insurance • Dental insurance • Vision insurance • Life insurance • Accidental death and dismemberment insurance • Disability insurance • Health savings account • Flexible spending account • Lifestyle spending account • Employee assistance program • Wellness program • Discounts • Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings) • Retirement plan with employer contributions • Paid time off • Paid State Sick Time • Paid holidays • Volunteer time • Jury duty • Bereavement leave