Quality Assurance Coder/Auditor

We are seeking a Quality Assurance Coder/Auditor to support a healthcare companies' Medicare & Medicaid Performance team.

In this role, you will be responsible for conducting HCC coding audits, reviewing medical records for coding accuracy, identifying risk adjustment opportunities, and educating providers on documentation and coding best practices. This position plays a key role in supporting risk mitigation efforts and ensuring compliance with Medicare Advantage coding guidelines

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Responsibiliti

• esReview medical records and supporting documentation to ensure accurate HCC and ICD-10 codi
• ngPerform quality assurance audits and maintain audit accuracy standards exceeding 9
• 5%Identify coding deficiencies and recommend corrective actio
• nsConduct risk adjustment and at-risk HCC analys
• isProvide education and training to providers and office staff on documentation and coding best practic
• esTrack audit findings and deliver recommendations to manageme
• ntValidate encounters, provider documentation, signatures, and coding compliance requiremen
• tsSupport vendor oversight and supplemental HCC data quality revie
• wsStay current on Medicare Managed Care, Risk Adjustment, and coding guideline chang

es
Required Qualificati

• ons5 years of professional medical coding experie
• nce3 years of HCC/Risk Adjustment coding experie
• nceStrong knowledge of ICD-10 coding guidelines and CMS Risk Adjustment methodolog
• iesHigh School Diploma or
• GEDOne of the following certificatio
• ns:CC
• S-P
• CRC
• CPC

COC
Preferred Qualificat

• ionsMedicare Advantage health plan experi
• enceExperience with HEDIS and/or CMS Star Ratings prog
• ramsRHIT or RHIA certifica
• tionClinical background (MA, LPN, RN,
• CNA)CPMA or CDEO certifica
• tionKnowledge of RADV au

dits
Interview Pr

• ocessRound 1: Onsite coding assessment with Team
• LeadRound 2: Interview with Hiring Ma

nager
Please note: Candidates must reside in Arizona and be able to work onsite one day per week onsite in Ph