What are the responsibilities and job description for the MRA Auditor position at Solis Health Plans?
Job Description
About us:
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!
Position is fully onsite Monday-Friday.
Location: 9250 NW 36th St, Miami, FL 33178.
**Bilingual in English and Spanish is required**
Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!
Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to almost 7,000 members in the last year!
Join our winning Solis Team!
Position Summary:
The MRA Auditor is responsible for reviewing medical records and practice management code data and making recommendations to providers as needed. Knowledge of medical coding guidelines, regulations, and understanding the impact of diagnosis coding on risk adjustment payment methods.
Essential Duties and Responsibilities:
Join Solis Health Plans as a Medical Risk Adjustment Auditor and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!
About us:
Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected, and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked, and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!
Position is fully onsite Monday-Friday.
Location: 9250 NW 36th St, Miami, FL 33178.
**Bilingual in English and Spanish is required**
Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!
Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to almost 7,000 members in the last year!
Join our winning Solis Team!
Position Summary:
The MRA Auditor is responsible for reviewing medical records and practice management code data and making recommendations to providers as needed. Knowledge of medical coding guidelines, regulations, and understanding the impact of diagnosis coding on risk adjustment payment methods.
Essential Duties and Responsibilities:
- Travel to offices as necessary to complete on-site chart reviews of medical records and determine if the medical record is complete, accurate, and in support of individual patient risk adjustment score. Codes will be sequenced and assigned from electronic medical systems such as International Classification of Diseases ICD-10, HCC Risk coding software, and AHA coding clinic software based on the code which most accurately describes each documented diagnosis.
- Reviews medical coding guidelines and regulations allowing to understand the impact of diagnosis coding on risk adjustment payment models including HCC, Chronic Illness Disability Payment System (CDPS)- Medicaid, Affordable Care Act (ACA-HHS)-Commercial payer models.
- Educates providers and their practice staff in Centers for Medicare & Medicaid Services (CMS), Health and Human Services - Affordable Care Act (HHS-ACA) and the Agency for Healthcare Administration (AHCA) coding guidelines. Focusing on documentation and accurate codes to enhance revenue opportunities.
- Works in collaboration with other departments, develop plans and materials that support education and system changes to meet practice and revenue goals.
- Reconciles internal and external reports to ensure pre or post review of each medical record is completed. Communicating recommendations to providers as appropriate, following up when necessary.
- Utilizes payor portal to identify missed, dropped or suspect HCC opportunities, and assigns appropriate coding disposition. Utilizes mining from data captured through historical risk adjustment coding reports.
- The above statement reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work required that may be inherent in the position.
- CPC, CPC-A, CCS-P or CRC Coding Certification
- Clinical knowledge to identify areas of improvement on documentation.
- Two (2) years of experience in Medicare Risk Adjustment Coding/Auditing.
- Must have reliable transportation.
Join Solis Health Plans as a Medical Risk Adjustment Auditor and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!
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