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Medical Records Audit & Training Consultant

Location: PA
JobFamily: Medical
Req #: PS62519
Date Posted: Feb 1, 2022

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SHIFT: Day Job

SCHEDULE: Full-time

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 care companies and a Fortune Top 50 Company.

Locations Preferred: NY; NJ; CT; PA; ME; NH; VA; GA

The Medical Records Audit and 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. 


Minimum Requirements: 

  • Requires BA/BS in health sciences, health management, or nursing and minimum of 5 years of ICD-9 coding or medical record audit experience in a consultative role; or any combination of education and experience, which would provide an equivalent background.
  • Professional coding certification 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.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.