HCC Risk Adjustment Quality Auditor
Summary
Perform remote audits of outpatient clinical documentation to validate HCC coding accuracy and ensure compliance with CMS risk-adjustment standards, while training providers and coders on best practices.
At UASI, we're driven by a mission to improve the quality and accuracy of clinical documentation through expert CDI consulting. As we continue to grow our service offerings, we’re looking for experienced and motivated HCC Risk Adjustment Quality Auditors to join our dedicated team in a fully remote capacity
As an HCC Auditor, this individual serves as a key quality and compliance resource by evaluating the accuracy and completeness of CDI staff reviews, validating HCC coding decisions, and ensuring adherence to CMS risk adjustment and organizational standards. This role requires advanced clinical and auditing expertise, critical thinking, and commitment to driving quality, consistency, and continuous improvement in risk adjustment documentation and coding practices.
Key Responsibilities:
- Utilize risk adjustment coding and HCC expertise to perform quality reviews on internal/subcontracted OP CDI staff.
- Use audit tool to analyze quality results and track overall quality.
- Prepare and deliver training on HCC documentation requirements, customized to the client audience (e.g., providers, HCC coders)
- Assess OP CDI chart reviews for missed documentation or query opportunities impacting RAF scores and outcomes
- Review charts to assure clinical documentation supports MEAT requirements and identify trends in documentation gaps
- Provide education to staff as needed based on audit findings.
- Identify trends and perform training to improve HCC capture and quality.
- Work with leadership to identify performance needs of OP CDI and create training to increase performance levels.
Qualifications
- 2-5 years of experience in HCC auditing, outpatient CDI, Risk Adjustment, or related healthcare documentation, including responsibility for quality review and compliance oversight.
- Active RN or LPN license required
- CCDS, CCDS-o, CDIP, CDEO and/or CRC certification strongly preferred
- Proficiency in Epic workflows, including interpretation and management of OurPractice Advisories/OPAs
- Strong understanding of ICD-10 coding guidelines, HCC documentation and coding requirements
- Excellent communication, critical thinking, and organizational skills.
- Comfortable using MS Office, email, VPNs, virtual machines, two-factor authentication, and video conferencing tools (MS Teams, Zoom, etc.).
Why UASI?
We believe that investing in our people is key to our success. In return for your talents, we offer a full benefits package, PTO and top pay! Additional benefits include:
- Collaborative, mission-driven team environment.
- Opportunities for continuous learning, education and professional growth.
- Leadership that values your expertise and input
Ready to make a difference and grow your career? We would love to hear from you!