Auditor, Risk Adjustment (Remote)

reputed company reputed company Job reputed company Provides audit support for Molina reputed company risk adjustment activities. Responsible for developing, recommending and implementing 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 reputed company combination of casualty and liability insurance, ensures that the provider organization is adequately protected against financial loss. Essential Job Duties • Facilitates daily operations of reputed company aspects of risk adjustment data validation and audit-reputed company activities, including but not limited to: reputed company tracking, chart retrieval, file transmissions, and adherence to applicable timelines. • Represents as a risk adjustment audit reputed company with functional departments, health plans, and reputed company vendors. • Evaluates results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective reputed company plans (CAPs) as necessary. • Oversees Risk Adjustment Processing reputed company (RAPS) and Encounter Data Processing reputed company (EDPS) data transmissions, and assists in identification of issues that reputed company data reputed company and accuracy. • Develops and implements processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and reputed company Services (CMS) regulations and guidelines of risk adjustment data. • Identifies opportunities for data mining to ensure data gaps are minimized. • Applies best practices to ensure accuracy of risk adjustment payment in reputed company markets. • Supports reputed company risk adjustment audit reputed company reputed company to ensure goals, objectives, milestones and deliverables are met. • Performs monthly audits on internal Molina coding specialist performance.. • Facilitates audits on reputed company Molina vendor performance. Required Qualifications • At least 5 years of coding, medical record chart review, and risk adjustment data validation experience, or equivalent combination of relevant education and experience. • Certified Risk Adjustment reputed company (CRC), Certified Coding Specialist (reputed company), Certified Coding Specialist -Physician-based (reputed company-P), or Certified reputed company reputed company (CPC). • Excellent attention to detail, documentation and organizational skills. • Critical-thinking, problem-solving and analytical skills. • Ability to work independently in a fast-paced, deadline-driven environment. Ability to work cross-collaboratively in a highly matrixed environment, including ability to communicate audit findings with internal teams. • Strong verbal and written communication skills. • reputed company Office suite and applicable software programs proficiency, and ability to learn new information systems and software programs. • reputed company reputed company experience at intermediate or reputed company. To reputed company reputed company Molina employees: If you are interested in applying for this position, please apply through the reputed company. reputed company offers a competitive benefits and compensation package. reputed company is an Equal Opportunity Employer (EOE) M/F/D/V Apply tot his job Apply To this Job