Anthem 
Glendale, CA 
Medical Record Audit & Training Consultant -Missouri Area Remote -PS27050
Location: United States
New
Requisition #: PS27050
Post Date: 6 days ago
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Medical Record Audit & Training Consultant PS27050
Summary: The Medical Record Audit & Training Consultant is responsible for evaluating and auditing physician and hospital medical records and medical assessment forms to ensure compliance with federal guidelines and medical documentation requirements.
Primary duties may include, but are not limited to:
Serves as final auditing arbiter regarding the Risk & Recovery"s Retrospective Risk Adjustment (RA) Coding Team.
Identifies training opportunities for internal and external stakeholders related to federal guidelines, best practices, and medical record documentation requirements.
Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
Provides feedback to Risk & Recovery leadership on performance improvement opportunities as a result of performance gaps.
Acts as a subject matter expert to internal and external stakeholders in the area of federal requirements and best practices.
Participates in and represents the department in business leadership groups, including external professional groups specializing in coding and provider education.
Assists the business with research and documentation of workflows and policies and procedures.
Qualifications:
Requires BA/BS in health sciences, health management, or nursing;
5 years of ICD-9/10 coding or medical record audit experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.
CPC from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) and CPMA (Medical Auditing Certification) from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders or Practice Management Institute) or equivalent certification required.
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 Diversity Inc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com.
An Equal Opportunity Employer/Disability/Veteran.
I assess risks by identifying potential hazards, analyzing their impact and likelihood, and developing strategies to mitigate them.
As Risk Management Consultants, we provide risk management support for a line of business. We assist in key risk identification, measurement, and aggregation. It is our job to assess and mitigate enterprise and business exposures. We identify key and emerging risks. Evaluating alignment with risk strategy is our responsibility. We monitor the risk and control environment to ensure that exposures are kept at acceptable levels. We partner with key stakeholders in the business. Identifying and documenting risks and controls is a part of our job. We assess risks associated with new or modified products. We are responsible for presenting findings to various levels of leadership. In this role, we communicate the results of risk assessments to governance committees and business process owners.
Core tasks:
