... complete chart reviews for risk adjustment. Demonstrated ability to perform quality audits of ... Work Environment Work primarily performed in office or remote environment. Travel may be required ...
... complete chart reviews for risk adjustment. Demonstrated ability to perform quality audits of ... Work Environment Work primarily performed in office or remote environment. Travel may be required ...
Remote Chart Audit information
What is a remote chart audit?
Remote chart audits are the process of reviewing and evaluating patient medical records electronically from a location outside of the healthcare facility. The purpose is to ensure accuracy, compliance with regulations, and completeness of documentation for billing, coding, and quality assessment. Professionals performing remote chart audits typically access electronic health records (EHR) securely to check for errors, missing information, or discrepancies. This role is crucial in maintaining healthcare standards, improving patient care, and preventing fraud. Remote chart audits allow for flexibility, as the work can be done from home or any location with secure internet access.
What are the key skills and qualifications needed to thrive as a remote chart auditor, and why are they important?
To thrive as a Remote Chart Auditor, you need expertise in medical coding, clinical documentation review, and a solid understanding of healthcare regulations, often supported by credentials like RHIA, RHIT, or CPC. Familiarity with electronic health record (EHR) systems, audit software, and coding tools such as ICD-10 and CPT is essential. Strong attention to detail, analytical thinking, and effective written communication are vital soft skills for ensuring accuracy and clarity in audit findings. These skills and qualifications are crucial for maintaining compliance, ensuring accurate billing, and supporting healthcare quality initiatives.
What are some typical challenges faced by professionals in remote chart audit roles, and how can they be managed?
Remote chart auditors often encounter challenges such as navigating varying electronic health record (EHR) systems, ensuring data privacy when accessing sensitive information from home, and efficiently managing communication with on-site staff. Staying organized and maintaining a secure, HIPAA-compliant work environment are essential. Regularly updating technical skills and proactively reaching out to team members for clarifications can help overcome these hurdles and foster effective collaboration.
What is the difference between Remote Chart Audit vs Remote Medical Biller?
| Aspect | Remote Chart Audit | Remote Medical Biller |
|---|---|---|
| Credentials | Knowledge of medical records, coding, and compliance | Medical billing certifications, CPT/ICD coding knowledge |
| Work Environment | Reviewing medical charts remotely, analyzing documentation | Processing insurance claims, billing patients remotely |
| Industry Usage | Healthcare, medical records management | Healthcare, insurance companies, billing services |
Remote Chart Audits and Remote Medical Billers both work in healthcare but focus on different tasks. Chart auditors review medical records for accuracy and compliance, while billers handle insurance claims and billing processes. Both roles require healthcare knowledge and often overlap in healthcare settings, but their primary responsibilities differ.
What are popular job titles related to Remote Chart Audit jobs in Utah?
For Remote Chart Audit jobs in Utah, the most frequently searched job titles are:
What job categories do people searching Remote Chart Audit jobs in Utah look for?
The top searched job categories for Remote Chart Audit jobs in Utah are:
What cities in Utah are hiring for Remote Chart Audit jobs?
Cities in Utah with the most Remote Chart Audit job openings:
Quality Assurance Risk Adjustment Auditor I/II
Salt Lake City, UT • On-site, Remote
Full-time
Medical, Dental, Vision, Retirement, PTO
Posted 29 days ago
Cambia Health Solutions rating
8.4
Based on 32 frontline employees who took The Breakroom Quiz
121st of 311 rated insurance
Job description
Risk Adjustment Auditor I or II
Hybrid role(3days/weekin office)atourPortland, Medford, Boise, Lewiston or Salt Lake Cityoffices. Candidates must reside within commutable distance of that location.
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team of Risk Adjustment Auditor is living our mission to make health care easier and lives better. As a member of the Risk Adjustment team, our The Risk Adjustment Auditor performs Retrospective/Prospective chart review utilizing various types of records to ensure accurate risk adjustment reporting. Responsible for assisting in second level reviews of all new HCCs identified through the first pass chart review process. Identifies trends in provider coding/documentation and vendor risk adjustment reporting and makes those trends known to leadership as well as coding team manager and training lead to develop intervention strategies - all in service of creating a person-focused health care experience.
Do you thrive as part of a collaborative, caring team? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
Risk Adjustment Auditor I would have an Associate degree in Healthcare or related field and one year of experience in clinical coding or auditing or equivalent combination of education and experience. Risk Adjustment, HCC or Inpatient coding experience required.
Risk Adjustment Auditor II would have an Associate degree in Healthcare or related field and three years of experience in clinical coding or auditing or equivalent combination of education and experience. Risk Adjustment, HCC or Inpatient coding experience required.
Required Licenses, Certifications, Registration, Etc.
CPC and CRC coding certification required
Skills and Attributes:
Demonstrated ability to perform accurate and complete chart reviews for risk adjustment.
Demonstrated ability to perform quality audits of internal and vendor coding.
Knowledge of and adherence to Official ICD-9-CM/ICD-10 Coding Guidelines.
Demonstrated analytical ability to identify problems, develop solutions, and implement actions in a timely manner.
Demonstrated ability to identify and communicate trends in provider and vendor coding and documentation.
Demonstrated proficient PC skills and familiarity with corporate software, such as Word, Excel and Outlook.
Effective verbal and written communication skills.
Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired
Additional Skills and Attributes for Risk Adj Auditor II
Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions for governmental and commercial products.
Advanced knowledge and understanding of risk adjustment, coding and documentation requirements.
Demonstrated ability to provide proactive and creative solutions to business problems.
What You Will Do at Cambia:
Performs Retrospective and Prospective chart reviews to ensure accurate risk adjustment reporting.
Performs quality reviews of vendor coding in support of the risk adjustment process
Verifies and ensures the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation.
Reviews medical record information to identify complete and accurate diagnosis code capture based on CMS HCC and HHS HCC categories.
Identifies trends in provider and vendor coding and documentation and partners with coding team manager and training lead to develop intervention strategies.
Supports and actively participates in process and quality improvement initiatives.
Maintains knowledge of relevant regulatory mandates and ensures activities are in compliance with requirements.
Consistently meets departmental performance and attendance requirements.
Additional Duties for Risk Adj Auditor II
Serves as a mentor to Risk Adjustment Auditor I staff.
Assists with special projects such as risk mitigation reviews.
Serves as subject matter resource regarding the risk adjustment process and diagnosis coding for risk adjustment.
Monitors and interprets regulatory changes that may impact administration of the Risk Adjustment Program. Assists with implementation activities as a result of regulatory changes to the Program.
Work Environment
Work primarily performed in office or remote environment.
Travel may be required, locally or out of state.
May be required to work overtime.
May be required to work outside normal hours.
Risk Adjustment Auditor I:
Oregon, Utah, and Idaho:The expected hiring range is$57,800.00 - $78,200.00, the full salary range is54,000.00 - $89,000.00and the bonus target is5%.
Risk Adjustment Auditor II:
Oregon, Utah, and Idaho:The expected hiring range is$69,700.00 - $94,300.00, the full salary range is$65,000.00 - $107,000.00and the bonus target is10%.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
- Work alongside diverse teams building cutting-edge solutions to transform health care.
- Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
- Grow your career with a company committed to helping you succeed.
- Give back to your community by participating in Cambia-supported outreach programs.
- Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
- Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
- Annual employer contribution to a health savings account.
- Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
- Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
- Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
- Award-winning wellness programs that reward you for participation.
- Employee Assistance Fund for those in need.
- Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.
We are an Equal Opportunity employer dedicated to a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
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About Cambia Health Solutions
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Portland, OR, US
Year founded
1996