Description
The Risk Adjustment Representative 3 conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies.
This role performs advanced administrative/operational/customer support duties that require independent initiative and judgment, and may apply intermediate mathematical skills.
Key responsibilities:
- Manage sites assigned and track records received to a specified goal
- Document progress and calls made daily, and complete daily productivity reports
- Research site information and update information internally
- Collaborate with IPA and Medical Groups
- Adapt to changes and business purposes
- Back up to leadership with processes and procedures
Required Qualifications
- High School Diploma
- 3 or more years of experience in a healthcare environment/managed care (provider office, billing, coding, medical records, etc.)
- Proficiency in Microsoft Office applications: Word, Excel, and PowerPoint
- Valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Strong written and verbal communication skills
- Organizational and time management skills
- Ability to travel up to 20% to provider offices within CA
- Understanding of IPA
Preferred Qualifications
- Medical record terminology
- Knowledge of contracting
Additional Information
- Monday - Friday business hours (8-5pm Pacific Time Zone)
- Overtime as needed
- Hours subject to change based on business needs
Work at Home Requirements
- Minimum download speed of 25 Mbps and upload speed of 10 Mbps
- Wireless, wired cable or DSL connection
- Dedicated workspace with minimal interruptions
Scheduled Weekly Hours
- 40
Pay Range
- $43,000 - $56,200 per year