Quality Review and Audit Analyst

Reason: Peak Period
Department: IFP RISK ADJUSTMENT
Job Category: Business Operations
Job Title: Quality Review and Audit Analyst
Duties: The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category
expertise to the role, evaluates complex medical conditions, determines compliance of medical documentation,
identifies trends, and suggests improvements in data and processes for Continuous Quality Improvement (CQI).

Key Job Functions:
• Conduct medical records reviews with accurate diagnosis code abstraction in accordance with Offic
ial Coding Guidelines and Conventions, Client IFP Coding Guidelines and Best Practices, HHS Protocols and any
additional applicable rule set.
• Utilize HHS' Risk Adjustment Model to confirm accuracy of Hierarchical Condition Categories (HCC)
identified from abstracted ICD-10-CM diagnosis codes for the correct Benefit Year.
• Apply longitudinal thinking to identify all valid and appropriate data elements and opportunities for data
capture, through the lens of HHS' Risk Adjustment.
• Perform various documentation and data audits with identification of gaps and/or inaccuracies in risk
adjustment data and identification of compliance risks in support of IFP Risk Adjustment (RA) programs,
including the Risk Adjustment Data Validation (RADV) audit and the Supplement Diagnosis submission
program. Inclusive of Quality Audits for vendor coding partners.
• Collaborate and coordinate with team members and matrix partners to facilitate various aspects of coding
and Risk Adjustment education with internal and external partners.
• Coordinate with stake holders to execute efficient and compliant RA programs, raising any identified risks
or program gaps to management in a timely manner.
• Communicate effectively across all audiences (verbal & written).
• Develop and implement internal program processes ensuring CMS/HHS compliant programs, including
contributing to Client IFP Coding Guideline updates and policy determinations, as needed.

Education & Experience:

The Quality Review & Audit Analyst will have a high school diploma and at least 2 years' experience in one of the
following Coding Certifications by either the American Health Information Management Association (AHIMA) or
the American Academy of Professional Coders (AAPC):

o Certified Professional Coder (CPC)
o Certified Coding Specialist for Providers (CCS-P)
o Certified Coding Specialist for Hospitals (CCS-H)
o Registered Health Information Technician (RHIT)
o Registered Health Information Administrator (RHIA)
o Certified Risk Adjustment Coder (CRC) certification

Minimum Qualifications
• Experience with medical documentation audits and medical chart reviews and proficiency with ICD-10-CM

coding guidelines and conventions
• Familiarity with CMS regulations for Risk Adjustment programs and policies related to documentation and

coding compliance, with both Inpatient and Outpatient documentation
• HCC coding experience preferred
• Computer competency with excel, MS Word, Adobe Acrobat
• Must be detail oriented, self-motivated, and have excellent organization skills
• Understanding of medical claims submissions is preferred
• Ability to meet timeline, productivity, and accuracy standards

3 Non-Negotiable Skills:

- HCC Knowledge or Experience (Basic)
- Certification needs to be active (at least 1)
- Basic knowledge of Microsoft products especially Excel
Skills: .
Keywords:
Education: .
Skills and Experience:
Required Skills:
MEDICAL DOCUMENTATION AUDITS
MEDICAL CHART REVIEWS
ICD-10-CM CODING GUIDELINES
ICD-10-CM CODING CONVENTIONS
CMS REGULATIONS FOR RISK ADJUSTMENT PROGRAMS
INPATIENT DOCUMENTATION COMPLIANCE
OUTPATIENT DOCUMENTATION COMPLIANCE
HIERARCHICAL CONDITION CATEGORIES (HCC) CODING
Additional Skills:
MEDICAL CLAIMS SUBMISSIONS
MICROSOFT EXCEL
MICROSOFT WORD
ADOBE ACROBAT
DETAIL ORIENTATION
SELF-MOTIVATION
ORGANIZATIONAL SKILLS
HCC CODING
UNDERSTANDING OF MEDICAL CLAIMS SUBMISSIONS
Languages:
English
Read
Write
Speak
Minimum Degree Required: Completed High School (Diploma or GED)
Certifications & Licenses:
AAPC
AHIMA Certification (American Health Information Management Association)
Certified Coding Specialist for Hospitals
Certified Coding Specialist for Providers
Certified Professional Coder
Certified Risk Adjustment Coder
Registered Health Information Administrator
Registered Health Information Technician
Patents: No
Publications: No
Veteran Status: No
# of Positions: 3

Schedule:
Start Date: 06/08/2026
Estimated End Date: 09/25/2026
Hours Per Week: 40.00
Hours Per Day: 8.00
Interview Notes: Monday - Friday no earlier than 6:30am EST and no later than 9am EST - work 8 hour shift with 30 minute lunch
Training Hours 9am - 5:30pm EST
100% Remote
Financials:

Currency USD

EEO:

"Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of - Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans."