MRA Auditor

Job Description

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 to learn more about us!

Position is fully onsite Monday-Friday. **Bilingual in English and Spanish is required**

Location: 9250 NW 36th St, Miami, FL 33178.

Full benefits package offered on the first on the month following date of hire including: Medical, Dental and Vision. 401K plan with a 100% company match after 90 days of employment!

Our company has doubled in size and we have experienced exponential growth in membership from 5,000 members to over 20,000 members!

Join our winning Solis Team!

Position Summary:

The Medicare Risk Adjustment (MRA) Auditor is responsible for reviewing medical records, disease state documentation practices, encounter data submission processes, practice management code data and preparing and delivering leading risk adjustment practice recommendations. Knowledge of medical coding guidelines, regulations, and risk adjustment models is required.

Position is onsite Monday-Friday.

Essential Duties and Responsibilities:

• Travel to medical offices as necessary to complete on-site chart reviews of medical records and determine if the medical record is complete, accurate, and support the risk adjustment scores. Reviews encounter submission process to ensure all required information is successfully transmitted to health plan.

• Reconcile patient assessments against known or suspected chronic conditions, including pre-visit preparation and post visit documentation.
• Educates providers and their practice staff on the Medicare Advantage HCC and RxHCC models medical coding guidelines and regulations.
• Trains provider groups on available Solis Risk Adjustment tools, including online portal and report extracts.
• Collaborates with other departments, developing plans and materials supporting education and system changes to meet practice business 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 chronic condition, and assigns appropriate coding disposition. Utilizes mining from data captured through historical risk adjustment coding reports.
• Strong communication skills.
• 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.

Qualifications:

• CPMA, CPC, and CRC coding certification is required.CCS-P is acceptable in lieu of CPC.
• CDEO certification is preferred.
• Expertise in Medicare Advantage HCC and RxHCC models
• Expertise in Medicare Advantage Risk Adjustment Data Validation (RADV) Audit process
• Clinical knowledge to identify areas of improvement on documentation.
• Minimum 3-4 years of experience in Medicare Risk Adjustment Coding/Auditing.
• Must have reliable transportation.

Compensation: $68k-73k based on experience and qualifications, plus a montly car and cellphone allowance

What Set Us Apart:

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!