Risk Adjustment Auditor II

Risk Adjustment Auditor II

Work from home within Oregon, Idaho or Utah 

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.  

Who We Are Looking For: 

Every day, Cambia’s dedicated team of Risk Adjustment Auditors  is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our Risk Adjustment Auditors perform Retrospective/Prospective chart reviews both on and off-site utilizing various types of records to ensure accurate risk adjustment reporting.  They also Identify trends in provider coding/documentation and works closely with Provider Education Consultants to develop intervention strategies – all in service of making our members’ health journeys easier.  

Do you have a passion for serving others and learning new things? Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit. 

What You Bring to Cambia: 

Qualifications:  

Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Coding Certification (CCA, CCS, CCS-P, CPC, or CPC-P) required. RADV, Risk Adjustment, HCC or Inpatient coding experience preferred.  

Skills and Attributes: 

• Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.

• Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.

• Demonstrates analytical ability to identify problems, develop solutions, and implement actions in a timely manner.

• Demonstrated ability to identify and communicate trends in provider coding and documentation.

• Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.

• Effective verbal and written communication skills.

• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.

• Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.

• Demonstrated ability to provide proactive and creative solutions to business problems.

What You Will Do at Cambia:  

• Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.

• Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.

• Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.

• Identifies trends in provider coding and documentation and partners with Provider Education Consultants to develop intervention strategies.

• Supports and actively participates in process and quality improvement initiatives.

• Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.

• Consistently meets departmental performance and attendance requirements.

• Serves as a mentor to Risk Adjustment Auditor I staff.

• Assists with special projects such as risk mitigation reviews.

• Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.

• Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program.  Assists with implementation activities as a result of regulatory changes to the Program.

Work Environment

• Travel may be required, locally or out of state.
• May be required to work overtime.
• May be required to work outside normal hours.

The expected hiring range for a Risk Adjustment Auditor II is $68,900.00 - $75,000.00 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 10%.  The current full salary range for this role is $64,000.00 to $106,000.00.

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About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care.  Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:  

• Work alongside diverse teams building cutting-edge solutions to transform health care.  
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.  
• Grow your career with a company committed to helping you succeed. 
• Give back to your community by participating in Cambia-supported outreach programs.  
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.  

We believe a career at Cambia is more than just a paycheck – and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.  

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include: 

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits. 
• Annual employer contribution to a health savings account.  
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays. 
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period). 
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave). 
• Award-winning wellness programs that reward you for participation. 
• Employee Assistance Fund for those in need. 
• Commute and parking benefits. 

Learn more about our benefits. 

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.