MRA Auditor

At ClareMedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the ClareMedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At ClareMedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to ClareMedica.

ESSENTIAL FUNCTIONS

We are seeking an accurate, detailed oriented Risk Adjustment Chart Reviewer to join our team. You will play a key role in reviewing medical records, insurance portals, internal reports and identifying, collecting, assessing, monitoring information for adherence to risk adjustment models. You will prospectively review all available medical records to ensure documentation accurately reflects and supports code selection, based on ICD-10 coding guidelines, which are submitted to the Health Plans for reimbursement based on the CMS Hierarchical Condition Categories (HCC) and RAF programs for Medicare Risk Adjustment reimbursement.

DUTIES AND RESPONSIBILITIES

• Reviews medical records via EMR, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, discharge summaries; and different portals to identify any chronic or new conditions to be sent to providers for validation.
• Analyzes MRA reports to identify and confirm unreported and/or unresolved medical conditions of members based on supportive medical documentation.
• Responsible for creating EMR template pre-visit prior to each patient’s appointment, to ensure providers can accurately capture all HCCs based on available documentation that supports any suggestions in the query.
• Performs ongoing analysis of medical charts for appropriate coding compliance and communicates findings of the HCC reports.
• Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to coding and documentation guidelines.
• Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives.
• Meet daily chart review production.
• Attends departmental meetings as required.
• Participates effectively in clinical documentation improvement initiatives and team meetings to promote quality across all projects.
• Complies with policies and procedures for confidentiality of all patient records and security of systems.
• Participate in the education process for new hires or RA training for providers.
• Conduct staff audits (like Providers; HDRR and Coders) or any RA audits as needed.
• Performs additional duties assigned by the Risk Adjustment Manager as needed.

SUPERVISORY RESPONSIBILITIES

This position does not have supervisory responsibilities.

QUALIFICATIONS/REQUIREMENTS

• Certified Professional Medical Auditor (CPMA) – certification; by AAPC or AHIMA is required.
• Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) - certifications; by AAPC or AHIMA is preferred.
• High school degree or equivalent; bachelor’s degree in related field preferred.
• Understanding of medical terminology, anatomy, and physiology.
• Strong computer skills in data entry, coding, and knowledge of Electronic Medical Record software; Microsoft Office Suite.
• Accurate and precise attention to detail.
• Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines and standard accepted practices.
• Ability to multitask, prioritize, and manage time efficiently.
• Must develop constructive and cooperative working relationships with others.
• Excellent verbal and written communication skills.
• Bilingual skills preferred (English/Spanish)
• Goal-oriented, organized team player.

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.

While performing the duties of this job, the employee will be required to stand, walk; sit; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Manual dexterity is required to use desktop computers and peripherals.

WORK ENVIRONMENT

Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

TRAVEL

Occasional travel to the centers and attend special continuous education seminars. Travel is primarily local during the business day.

SAFETY HAZARD OF THE JOB