JOB REQUIREMENTS: Medical Coding Audit Specialist Administration - 1265 John Q. Hammons Drive, 1265 John Q. Hammons Dr. , Madison, Wisconsin, United States of America Req #1966 Friday, December 27, 2024 Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER 1.0 FTE / 40 hours per week. GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard. Join our team and receive training, resources, competitive pay and exceptional benefits including free parking at all our locations! Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW. The Medical Coding Audit Specialist - Risk Adjustment is responsible for chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for ACA risk adjustment services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for REGTAP webinars and communications. Determines adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment. As assigned, the incumbent may assist the Medical Coding Supervisor in various administrative tasks. The Medical Coding Audit Specialist works under the general supervision and guidance of the Revenue Cycle Manager. Job Specific Minimum Qualifications High school graduation or equivalent is required. Completion of an accredited Medical Coding Specialist Program or equivalent combination of education and/or relevant work experience is required. Certification as a CPC or CCS-P is required. Ability to obtain Certified Risk Adjustment Certification (CRC) from American Academy of Professional Coders (AAPC) within 6 months of hire. Five (5) years\' experience to include medical chart reviews, risk adjustment experience with in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding is required. Knowledge of medical terminology, basic anatomy, physiology, and disease process is required. Knowledge of Medicare and Medicaid rules and regulations is required. Knowledge of or ability to learn various... For full info follow application link. Group Health Cooperative is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status or disability. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/968C0F51F8354F25