UPMC Health Plan has an exciting opportunity for a Risk Adjustment Clinical Auditor/Analyst position in the Medicare department. This is a full time position working Monday through Friday daylight hours and will be fully remote..
The Clinical Auditor/Analyst is an integral part of the Risk Adjustment Department and is responsible for reviewing and auditing medical records for Hierarchical Condition Category (HCC) diagnosis codes for focused claims reviews and government audits. Performs medical records reviews, and auditing functions including monitoring, reviewing, and researching ICD-10-CM diagnosis codes and CPT Codes. Ensure HCC diagnosis code(s) are supported within the audit year, and utilize AHA Coding clinics, ICD-10-CM Coding Guidelines, CPT Coding Guidelines, and government regulations. Participate in government audits conducting research of internal systems and abstracted records of member’s selected for audit.
Responsibilities:
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