Auditor, Risk Adjustment (Remote)
Job Description
Job Summary Develops, recommends, and implements controls and cost-effective approaches to minimize the organization's risks effects. Identifies and analyzes potential sources of loss to minimize risk and estimates the potential financial consequences of an occurring loss. Through the proper combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss. Knowledge/Skills/Abilities
- Assist in the daily operations of all aspects of risk adjustment data validation activities, including progress tracking, chart retrieval, file transmissions, and adherence to timelines.
- Support risk adjustment audit projects to ensure goals, objectives, milestones, and deliverables are met.
- Evaluate audit results to address barriers, gaps, opportunities for improvement, and implement corrective actions.
- Act as an audit liaison with departments, health plans, and external vendors.
- Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with CMS regulations and guidelines of risk adjustment data.
- Oversee RAPS and EDPS data transmission and identify issues impacting data integrity and accuracy.
- Identify opportunities for data mining to minimize data gaps.
- Apply best practices to ensure accuracy of risk adjustment payments across markets.
- Perform monthly audits on internal Molina Coding Specialists and external vendors.
Job Qualifications Required Education Associates degree. Required Experience At least 3 years in coding, medical record chart review, and risk adjustment data validation. Required License, Certification, Association Active and unrestricted Coding Certification (CCS, CCS-P, or CPC). Preferred Education Bachelor's Degree in Business Administration, Healthcare Management, or related field. Current Molina employees interested in applying should do so through the intranet job listing. Molina Healthcare offers competitive benefits and compensation. We are an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $77,969 - $128,519 annually.
- Actual compensation may vary based on location, experience, education, and skills.
#J-18808-Ljbffr Salary: USD 77969 - 128519 per year Experience: 3 years required