Auditor, Corp Compliance

Posting Date

DaVita IKC is seeking a highly motivated and experienced Medicare Risk Adjustment Auditor and Educator to join our compliance team. This role is crucial for ensuring the accuracy, integrity, and compliance of our risk adjustment coding and clinical documentation related to professional services provided by both internal and external nephrology partners. The ideal candidate will serve as a subject matter expert, performing detailed medical chart audits and providing targeted education to providers and coding teams to support our commitment to high-quality patient care and adherence to all formal regulatory and coding guidelines.

Essential Duties and Responsibilities

Auditing, Analysis, and Compliance

• Ensure that IKC is compliant with industry regulations and published coding guidelines.
• Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes and ensure documentation supports submitted diagnoses for Medicare Risk Adjustment (HCC coding).
• Perform detailed internal and external coding audits on a regular basis as defined by compliance requirements, including for our nephrology partners.
• Execute targeted audit plans, including performing targeted audits of identified HCC outliers.
• Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings.
• Prepare and present formalized audit reports to leadership, summarizing findings, identifying risk areas, and recommending corrective action plans.
• Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits, by preparing documentation and responding to inquiries.
• Perform necessary research to provide supportive regulatory and coding guideline documentation.

Education and Training

• Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines.
• Provide one-on-one and group education sessions based on audit findings, tailoring content to address specific needs and knowledge gaps.
• Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions.
• Stay current with official coding guidelines from CMS, HHS, and other regulatory bodies to ensure all educational content is accurate and up-to-date.

Core Values and Professional Responsibilities

• Maintain meticulous records of audit findings, educational sessions, and follow-up actions to ensure a clear audit trail.
• Participate in special projects related to process improvement, compliance, and coding initiatives as assigned.
• Maintain strict confidentiality of patient and proprietary information.
• Demonstrate and exemplify behavior consistent with DaVita's core values: Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment, and Fun.

Minimum Qualifications and Experience

• Certifications: Current coding certification from AAPC or AHIMA is required (CCA and CPC-A are not accepted).
• Experience:
  • 3+ years of coding experience.
  • 2-3 years' minimum recent experience performing medical audits for diagnosis coding.
  • Proven experience in developing and delivering education and training to clinical providers and coders is highly preferred.
• Skills:
  • Strong computer skills, including the ability to utilize various EMR systems and Microsoft Office.
  • Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models.
  • Deep understanding of coding and documentation compliance, including CMS and HHS regulations.
  • Excellent verbal and written communication skills, with the ability to present complex information clearly.
  • Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail.
  • Demonstrated ability to work independently and collaboratively in a fast-paced, team-oriented environment.

What We'll Provide:

More than just pay, our DaVita Rewards package connects teammates to what matters most. Teammates are eligible to begin receiving benefits on the first day of the month following or coinciding with one month of continuous employment. Below are some of our benefit offerings.

• Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Support for you and your family: Family resources, EAP counseling sessions, access Headspace , backup child and elder care, maternity/paternity leave and more
• Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita's online training platform StarLearning.

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At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.

This position will be open for a minimum of three days.

Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at https://careers.davita.com/benefits

Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.