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Coding Auditor (Risk Adjustment)

Location: Tampa, FL
JobFamily: Medical
Req #: PS63466
Date Posted: May 17, 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 benefits companies and a Fortune Top 50 Company.

Coding Auditor - Work from home! ***Must be located in the state of Florida***

The Coding Auditor is responsible for auditing diagnosis data collected from physician and hospital medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements. 

Primary duties may include, but are not limited to: 

** Risk Adjustment Coding Experience Highly Preferred. **

  • Collects and analyzes data to formulate recommendations and solutions based on audit trends and results. 
  • Provides regular feedback to Operations leadership on performance improvement opportunities as a result of performance gaps. 
  • Participates in and represents the department in business leadership groups. 
  • Assesses and identifies training opportunities. 
  • Assists the business with research and documentation of workflows, policies and procedures and other materials. 
  • Maintains current knowledge of requirements and guidance required in the performance of audit duties. 
  • Reviews medical records that have been reviewed and coded by the coding vendor. 


Minimum Requirements:

  • High School diploma or GED equivalent.
  • At least 1 year of risk adjustment experience coding of medical records in a physician office, hospital, or insurance/coding office setting; or any combination of education and experience, which would provide an equivalent background. 
  • CPC, CRC, CCS - Medical Coder certification from accredited source (e.g. American Health Information Management Association, American Academy of Professional Coders) required.
  • HCC coding knowledge required.  

** Risk Adjustment Coding Experience Highly Preferred. **

Preferred Qualifications:

  • BS in health sciences, health management or related field preferred
  • Experience working with Medicare Advantage preferred.

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.

The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against Covid-19. All offers of employment are conditioned on completion of a background check, including COVID-19 vaccination verification. If you are not vaccinated, your offer will be rescinded unless you provide – and Anthem approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws.

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 Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

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.