Medical Record Auditor

Associate would be in charge of conducting Medical Records reviews to identify HCCs (short-term insurance) that still haven't been submitted to CMS (tools provided by the department). Collect the medical records that support those findings upload in to our tool and code it.

Evaluates and audits physician and hospital medical records and medical assessment forms to ensure compliance with CMS guidelines and medical documentation requirements. Responsible for serving as final auditing arbiter regarding the Sr. Risk & Recovery’s Retrospective Risk Adjustment (RA) Coding Team and responsible for the identification of training opportunities for our internal and external stakeholders related to CMS guidelines, HCC best practices and medical record documentation requirements. 

Essential Functions:

• Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.

• Provides regular feedback to Sr. Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps.

• Acts as a subject matter expert to internal and external stakeholders in the area of CMS requirements and HCC best practices.

• Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education.

• Assists the business with research and documentation of workflows and policies and procedures.