The Senior Compliance
Auditor will primarily provide auditing oversight of the Risk Adjustment and
Hierarchal Condition Categories (HCC) coding and billing audits, as well as
assisting with compliance reviews, investigations, and other projects,
supporting the department’s mission of fostering a culture of ethics and
compliance through the implementation of a proactive, collaborative, and
reliable ethics and compliance program. The Senior Compliance Auditor is
responsible for management, implementation and delivery of assigned audit
phases, including planning, fieldwork, and reporting of HCC Risk Adjustment,
Healthcare Effectiveness Data and Information Set (HEDIS) and other reporting.
Minimum Education: Bachelor’s degree in a related field or
combination of experience/education required.
Minimum Years of Experience: 3 years of directly related
experience as an RADV or HCC Risk Adjustment Auditor with operational audit
experience in RADV or other high-risk coding platforms.
Substitutable Education & Experience: A Bachelor’s degree
and 3 years of experience can be substituted for the following combinations of
education/experience: High School Diploma with 7 years of directly related
experience; Associates Degree with 5 years of directly related experience.
Required Certifications/Licensure: Certified Professional Coder
(CPC), Certified Risk Coder (CRC), or other comparable coding certification.
Strong analytical and problem-solving skills;
Ability to articulate orally and in writing an understanding of
complex issues and detailed action plans;
Proficient in utilization of electronic health records, (e.g.
Proficient in Audit Reporting and oversight of Risk Adjustment
or HCC program;
Leading a variety of independent assurance, operational and
regulatory reporting processes;
Proficiency in Microsoft Office