Remote Risk Adjustment Auditor Jobs in Michigan (NOW HIRING)

Purpose

Uses specialized knowledge to support key areas of the organization related to an area of expertise. Uses data, research analysis, critical thinking & problem-solving skills to support colleagues & leadership in achieving organization's strategic objectives. Serves as a peer influencer & may direct a project or project team by applying industry experience & specialized knowledge.

Essential Functions

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.
Work Focus:
Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution.
Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience.
Responsible for distribution of analytical reports.
Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of Trinity Health policies, practices & processes to ensure quality, confidentiality & safety are prioritized.
Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.
Data Management & Analysis:
Research & compiles information to support ad-hoc operational projects & initiatives.
Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making.
Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.
Maintains a Working Knowledge of applicable federal, state & local laws / regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects honest, ethical & professional behavior & safe work practices.

Functional Role (not inclusive of titles or advancement career progression)

• Obtain appropriate clinical documentation through extensive interaction with providers and coding staff to ensure documentation reflects level of service rendered to patients is complete and accurate.

• Validate the accurate assignment of working HCC diagnosis affecting RAF scores within the ambulatory patient population by collaborating with physicians & advanced practice providers.

• Conduct thorough prospective & sometimes retrospective quality reviews of ambulatory patient records, documenting all relevant findings & tracking key information through the process.

• Identify areas where documentation requires clarification & engagement with physicians, advanced practice providers & other healthcare professionals to effectively resolve discrepancies.

• Ensures medical record documentation is accurate, complete, & compliant, supporting acute or chronic conditions & medical necessity.

• Applies through understanding of payment structures, outpatient reimbursement models, & the impact of provider documentation & HCC risk adjustment, ensuring compliance with reporting standards for claims submission.

• Identifies patterns & trends impacting documentation & coding & acts as a technical resource related to documentation, coding & billing regulations for assigned service area.

• pay grade 13 range 75,592.7054-113,389.0581 Actual compensation will fall within the range but may vary based on factors such as experience, qualifications, education, location, licensure, certification requirements, and comparisons to colleagues in similar roles.

Minimum Qualifications

• Associate's degree in Business, healthcare, Nursing or related field, or equivalent combination of education & experience

• Experience with compliant healthcare documentation, HCC coding requirements, alternate payment models in a multi-facility, integrated health care delivery system, revenue cycle or consulting experience.

• Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Integrity (CDI), Certified Clinical Documentation Specialist - Outpatient (CCDS-O), Certified Documentation Expert Outpatient (CDEO), or Certified Documentation Integrity Practitioner (CDIP) credential with coding or clinical documentation integrity experience.

Additional Qualifications (nice to have)

• Bachelor's degree in nursing, HIM or related healthcare field.

Physical & Mental Requirements & Working Conditions (General Summary)

Direct Healthcare Services / Indirect Healthcare / Support Services:

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell. Occasional

• Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.). Occasional

• Exposure to or subject to noise, infectious waste, diseases & conditions. Occasional

• Exposure to interruptions, shifting priorities & stressful situations. Frequent

• Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects. Continuous

• Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise. Frequent

• Perform manual dexterity activities & / or grasping / handling. Occasional

• Ability to climb, kneel, crouch & / or operate foot controls. Occasional

• Use a computer / other technology. Frequent

• Sit with the ability to vary / adjust physical position or activity. Continuous

• Maintain a safe working environment & use available personal protective equipment (PPE). Continuous

• Comply with applicable Code of Conduct, policies, procedures & guidelines. Continuous

• Ability to provide assistance in the event of an emergency. Occasional

Direct Healthcare Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Frequent

• Lift a maximum of 30 pounds unassisted. Occasional

• Use upper & lower extremities, engage in bending / stooping / reaching & pushing / pulling. Occasional

• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous

• Encounter worksites (e.g., patient homes) or travel to worksites that may have variable internal & external environmental conditions. Occasional

• Perform work that involves physical efforts (e.g., transporting, moving, positioning & / or ambulating patients). Occasional

Indirect Healthcare / Support Services:

• Perform activities that require standing / walking with the ability to vary / adjust physical position or activity. Occasional

• Lift a maximum of 30 pounds unassisted. Occasional

• Experience of long periods of walking / standing / stooping / bending / pulling & / or pushing. Occasional

• Encounter a clinical / patient facing / hands on interactive work environment. Occasional

• Work indoors (subject to travel requirements) under temperature-controlled & well-lit conditions. Continuous

• Work outdoors with variable external environmental conditions. Occasional

Average Workday Activity: Occasional - O (1% - 33%), Frequent - F (34% - 66%), Continuous - C (67% - 100%)

The above statements provide a representative description of the nature & level of work being performed by persons assigned to positions within this job description. This is not an exhaustive list of essential functions, conditions & duties; other job-related tasks may be required. Additional detail may be provided by policies, procedures, guidelines, protocols, standards & other communications. Requests for reasonable accommodation will be considered in compliance with federal, state & local law.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.