Medicare Advantage Risk Adjustment Provider Documentation Trainer and Auditor

As the Medicare Advantage Risk Adjustment Provider
Documentation Trainer and Auditor, you will be an expert in risk adjustment coding and documentation,
working closely with physicians, IPA coders, and risk adjustment teams associated
with the health plan. You will:

• Conduct medical record audits for physicians
  (MD, DO, or NP) to ensure documentation and coding accuracy of ICD-10 CM codes
  related to chronic conditions
• Analyze coding patterns within medical groups.
• Provide customized education and updating
  educational materials for providers and medical groups.
• Participate in additional audit activities for
  CMS RADV as needed, including retrospective chart reviews.
• Travel to provider offices within Los Angeles
  area at least three days a week.

We are seeking a proactive, highly organized,
detail-oriented individual with:

• A Certified Professional Coder (CPC) certification
  and a Certified Risk Adjustment Coder (CRC), required
• Bachelor's degree (healthcare or relevant field)
  or equivalent experience/training
• Five or more years of experience with physician
  billing and/or coding, required
• Three or more years of recent experience in
  CMS-HCC Risk Adjustment models V24 and V28, required
• Three or more years of experience in providing
  education to clinical and non-clinical staff, required
• Six or more years of clinic or IPA and/or
  managed care experience, preferred
• Understanding of RADV and audit processes,
  required
• Detailed knowledge and understanding of ICD-10,
  CPT and CPT (II), and HCPCS coding systems required
• Knowledge of Medicare Advantage STARS/HEDIS
  program and NCQA technical specifications, required
• Knowledge of Medicare Advantage billing/claims submission
  and other related actions, preferred
• Knowledge of HIPAA requirements, anatomy and
  physiology, required
• Proficient in MS Word, Excel, PowerPoint and
  Outlook, required
• Ability to work effectively with common office
  software, coding software, and EMR systems, required
• Reliable transportation to conduct ongoing
  face-to-face interactions with providers in the Los Angeles area, required