Risk Adjustment Auditor I

at  Baylor Scott White Health

JOB SUMMARY

Accountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health risk adjustment strategies and processes for lines of business subject to risk adjustment.

QUALIFICATIONS

• EDUCATION - Associate’s or 2 years of work experience above the minimum qualification
• EXPERIENCE - 2 Years of Experience

• Conducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology
• Interprets health record documentation to code and abstracts diagnoses and/or procedures for inpatient, outpatient, and clinic cases
• Conducts focused HCC reviews on providers and clinics, tracks results and identifies trends and deficiencies for follow-up
• Researches complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and the Federal Register, and sharing knowledge with co-workers, as directed
• Assists Risk Adjustment Auditor 2 or Manager with educator duties in the clinics on occasional based, as needed
• Protects data integrity and validity
• Maintains and respects patient confidentiality for accessing and disclosure of health information