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 related activities, including, but not limited to : progress tracking, chart retrieval, file transmissions, and adherence to applicable timelines

Support all risk adjustment audit related projects to ensure goals, objectives, milestones and deliverables are met

Evaluate results from audit activities to address barriers, gaps, opportunities for improvement, and implement corrective action plans as necessary

Acts as an audit liaison with other departments, health plans, and external vendors

Develop and implement processes and procedures to ensure accuracy, completeness, and compliance with Centers for Medicare and Medicaid Services (CMS) regulations and guidelines of risk adjustment data

Understand and oversee RAPS and EDPS data transmission and assist in identification of issues that impact data integrity and accuracy

Identify opportunities for data mining to ensure data gaps are minimized

Apply best practices to ensure accuracy of risk adjustment payment in all markets

Performs monthly audit on internal Molina Coding Specialists

Audits external Molina Vendors.

Job Qualifications

Required Education

Associates degree.

Required Experience

3 Years in coding and medical record chart review and experience with risk adjustment data validation

Required Li

Required License, Certification, Association

Active and unrestricted Coding Certification, Active CCS, CCS-P, or CPC credential

Preferred Education

Bachelor's Degree in Business Administration, Health Care Management o

To all current Molina employees : If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M / F / D / V.

Pay Range : $77,969 - $128,519 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and / or skill level.