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University of Maryland Medical System
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Risk Adjustment Auditor I
JOB SUMMARYAccountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health risk adjustment strategies and processes for lines of business subject to risk adjustment.ESSENTIAL FUNCTIONS OF THE ROLEConducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment MethodologyInterprets health record documentation to code and abstracts diagnoses and/or procedures for inpatient, outpatient, and clinic casesConducts focused HCC reviews on providers and clinics, tracks results and identifies trends and deficiencies for follow-upResearches complex coding HCC issues and keeps abreast of coding and compliance changes as commu
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