RISK ADJUSTMENT NURSE AUDITOR - CORPORATE COMPLIANCE - Position #2019-101
- Date Posted:
- Full Time
- OPEN UNTIL FILLED - Redlands Monday - Friday - 8:00a.m. - 5:00p.m.
Risk Adjustment Nurse Auditor position performs clinical audit/validation
processes to ensure that medical record documentation and diagnosis coding for
services rendered to Medicare Advantage patients is complete, compliant and
accurate to support optimal reimbursement based upon industry accepted clinical
guidelines. This position conducts audits that require significant independent
decision making and is considered the expert in accomplishing the quality of
the processes to ensure optimum reimbursement.
The Risk Adjustment Nurse Auditor develops the clinical operational
framework focused on scalable and repeatable best practices as it relates to
Risk Adjustment. This position supports and aligns planning to ensure that key
strategic activities aimed at risk adjustment management initiatives are
implemented and goals are met.
Associates Degree, CPC or CRC certification, and
a current and valid LVN licensure. Five or more years of experience as an LVN in a
clinical setting. Five years in
outpatient clinical setting with two or more years of experience in the education/training
of clinical staff preferred. Active LVN Licensure, current BLS (American
Heart Association). Extensive knowledge of internal medical group operations
and a high degree of interpersonal skills are required. Must be proficiently skilled in the application
and use of Windows, Word, PowerPoint, Excel, GroupWise and the Internet.
Applications must be complete and demonstrate that the
minimum qualifications are met. Resumes may be attached to completed
application form as supplemental information, but will not be accepted in lieu
of an official application form. Applications will be screened and the most
qualified candidates who best match the needs of the position will be invited
to compete further in the recruitment process. Due to the large volume of applications received, we are unable to
track for individual applications or discuss the application process.