Quality Review and Audit Analyst
Skills
AcademiesContent Management SystemsContinuous ImprovementData ValidationElectronic Data CaptureMatrixgoldMedical Claims
What the job involves
The main requirements, responsibilities and hiring steps.
Requirements
- High school diploma
- 2+ years experience with AHIMA or AAPC coding certification
- Must hold or obtain CRC certification within 6 months if not already CRC certified
- Experience with medical documentation audits and medical chart reviews
- Proficiency with ICD-10-CM coding guidelines and conventions
- Familiarity with CMS risk adjustment regulations and coding compliance
- HCC coding experience preferred
- Computer competency with Excel MS Word and Adobe Acrobat
- Detail oriented self motivated and highly organized
- Ability to meet timeline productivity and accuracy standards
Nice to have
- Detail oriented
- Self motivated
- Highly organized
- Excellent communication
Day to day
- Conducts medical record and chart reviews to abstract diagnosis codes accurately and verify HCC accuracy using official coding guidelines and HHS risk adjustment rules.
- Performs documentation and data audits to find gaps inaccuracies compliance risks and opportunities for continuous quality improvement.
- Collaborates with internal and external partners to support coding education program execution and timely risk reporting.