**Fully Remote. Must live in the state of FL to qualify**

To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by effectively monitoring overall risk adjustment efforts. The individual will be responsible for auditing diagnosis codes discovered by the Government Programs Risk Adjustment Team. The individual will provide superior quality by educating internal staff of errors and opportunities for improvement discovered during routine auditing. This individual will work closely with the Director of Government Programs and the Manager of Risk Adjustment to implement benchmarks, establish acceptable thresholds, and effective quality assurance programs.

Primary Accountabilities

• Develop, implement and maintain a quality assurance program for data collected by the Risk Adjustment Team.
• Monitor the performance of the Risk Adjustment Team and report findings to Senior Leadership in a timely, consistent and effective manner ensuring that appropriate changes are implemented.
• Manage audit processes ensuring work flows and results are properly documented and maintained. Identify and implement process improvements as needed.
• Train new auditors as needed.
• Perform chart reviews as needed.
• Participate in CMS audits of our Risk Adjustment activities, including by not limited to Risk Adjustment Data Validation audits.
• Serve as the system administrator for the compliance tracking software at HFHP, to include the monitoring of data entered into the system to ensure accuracy, developing and maintaining data entry workflows and manuals, providing additional training to users, and contacting the vendor for assistance when necessary.
• Assist in the development of a monthly Compliance Program Report to effectively capture current activities, issues, trends, and oversight related to compliance issues within HFHP.
• Assist in the development and distribution of annual Risk Assessment surveys for various departments within HFHP
• Ensure new diagnosis codes and HCCs identified by the HFHP Risk Adjustment Team are valid and substantiated in the patient's medical record.

**Fully Remote. Must live in the state of FL to qualify**

• Four year degree from accredited college/university and a minimum of two to four years’ experience in an audit or compliance capacity or a minimum of three years in a position responsible for program compliance and training with some college.

• Certified coder with a minimum of two to four year's coding experience.

• Expert knowledge of Medicare Risk Adjustment preferred.

• Research and problem resolution skills.

• Personal computer skills a must, proficient in word processing, graphics and spreadsheet manipulation and basic understanding of the Internet.

• Exceptional interpersonal relationship skills.

• Demonstrates excellent written and verbal communication skills conforming to all rules of punctuation, grammar, diction and professional style.

• Presents professional image to the public.

• Experience in initiating, developing and monitoring policies, internal control procedures and operating standards.

• Ability to navigate constructive conversations on behalf of the health plan with State and Federal officials.

• PAHM or other health care related certification preferred. Will be required within 1 year of employment