Remote Risk Adjustment Auditor Jobs in Georgia (NOW HIRING)

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• Comprehensive health benefits that start day 1 

• Student Loan Repayment Assistance & Reimbursement Programs 

• Family-focused benefits  

• Wellness incentives 

• Ongoing mentorship, development, and leadership programs  

• And more 

Overview:

The Clinical Documentation Integrity (CDI) data analyst is responsible for strategic and operational support through the analysis of clinical, financial, and coding claims data. This role requires leveraging abstraction and analysis of datasets such as MEDPAR, Vizient, Quality and internal claims data to benchmark performance and identify areas for improvement in CDI, coding and provider documentation practices. The CDI Data analyst will play a key role in driving improvements in case mix index (CMI), risk adjustment, and departmental focus on identified trends. The CDI Data Analyst will work directly with CDI Director and closely with vendors to obtain data analysis insights through applications such as EPIC, Solventum and Vizient to support business processes, working in collaboration with digital teams to make appropriate business application decisions.

Primary Duties and Responsibilities:

• Data extraction and Validation:
  • • 1. The CDI analyst is advanced in programing language. Ability to write code, merge data from multiple sources, validate findings and mining unstructured data for meaningful metrics.
    • 2. Collecting, analyzing, and interpreting clinical documentation data to identify trends, patterns and areas for improvement.
• Performance Metrics and Trend Analysis:
  • • 1. Analyze data trends in documentation quality to identify patterns and gaps for areas of focus and improvement for financial and quality health.
• Reporting and Dashboard Development:
  • • 1. Create dashboards and visual reports for CDI Leadership, physicians and quality teams to determine actionable metrics.
    • 2. Track KPI such as financial impact, risk adjustment trends, quality PSI/HAC Trends, and provider performance.
• Support compliance and Audit Readiness:
  • • 1. Monitor documentation practices for alignment with CMS, ICD-10 and Payer requirements.
    • 2. Assist in preparing data for internal audits and external reviews.
• Collaboration and Strategic Insights:
  • • 1. Work with CDI Specialists, coders, and clinical teams to translate data insight into documentation strategies.
    • 2. Provide feedback loops to improve provider education and CDI workflows.

Travel: Less than 10% of the time may be required.

Work Type: Remote employee - Works from locations outside traditional office, often from home or another remote setting.

Minimum Required Qualifications:

• Education - Bachelor's degree in Computer Sciences, HIM, Data analytics,
• Nursing Experience - 4 years minimum experience

Knowledge, skills, and abilities (required): 

• SQL, SAS, Python, Excel, Power-BI, Tableau, AWS/Azure, and cloud applications
• Strong analytical and problem-solving skills, proficiency in data analysis tools, excellent communication and interpersonal skills, with ability to work independently and as part of a team. 
• Knowledge of clinical documentation standards, regulatory requirements and healthcare industry practices is required.
• Programming language

Preferred Qualifications Education:

• Master's Degree in Computer Sciences, HIM, Data analytics,
• Nursing Experience - 6 years minimum experience
• Licensure - Licensed Registered Nurse, GA Board of Nursing certified
  PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs., 0-33% of the work day (occasionally) Lifting 25 lbs. max; Carrying of objects up to 25 lbs.; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.
  ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include but are not limited to: Blood-borne pathogen exposure, Bio-hazardous waste chemicals/gases/fumes/vapors, Communicable diseases, Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.

ACCOMMODATIONS: EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Leave and Accommodations.  

PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks. 
ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.