job description
Join Vee Healthtek as a Pre-Visit Risk Adjustment Auditor and play a pivotal role in ensuring accuracy and compliance in healthcare risk adjustment processes. This remote position, based in Bali, offers a unique opportunity to contribute to prospective reviews that directly impact patient care and financial integrity.
In this role, you will conduct thorough audits of pre-visit medical records, identifying gaps in documentation and ensuring that risk adjustment factors (RAFs) are accurately captured. Your expertise will help healthcare providers optimize revenue while maintaining strict adherence to regulatory standards.
Ideal for detail-oriented professionals with a background in medical coding, auditing, or healthcare compliance, this position combines analytical rigor with the flexibility of remote work in one of the worldâs most inspiring locations.
Responsibility
- Conduct comprehensive audits of pre-visit medical records to validate risk adjustment factors (RAFs).
- Identify documentation gaps, coding errors, and potential compliance risks in prospective reviews.
- Collaborate with healthcare providers to ensure accurate and complete patient data submission.
- Generate detailed audit reports with actionable recommendations for process improvements.
- Stay updated on CMS guidelines, ICD-10 coding standards, and risk adjustment methodologies.
- Train and mentor clinical staff on best practices for documentation and coding accuracy.
- Monitor audit trends and provide insights to reduce denials and optimize revenue cycles.
- Ensure all audits adhere to HIPAA and other regulatory compliance requirements.
Qualifications
- Bachelorâs degree in Nursing, Health Information Management, or a related field. Certified Professional Coder (CPC) or Certified Risk Adjustment Coder (CRC) preferred.
- Minimum 3 years of experience in medical coding, auditing, or risk adjustment (HCC/RAF models).
- Proficiency in ICD-10-CM, CPT, and HCPCS coding systems.
- Strong understanding of CMS risk adjustment programs (e.g., Medicare Advantage, ACA).
- Excellent analytical skills with the ability to interpret complex medical records.
- Experience with audit software (e.g., Epic, Cerner, or proprietary tools) is a plus.
- Exceptional communication skills to articulate findings to non-clinical stakeholders.
- Ability to work independently in a remote setting with a stable internet connection.