Certified Medical Coder/Clinical Quality Auditor  position located in our Worthington, OH office.  Position will support the risk adjustment division through extraction of diagnosis information obtained  from physician offices  and hospitals  throughout the U.S.  Approximately  25 % travel .

The Clinical Quality Auditor in this position will be responsible for insuring clinical quality through an audit process.   Acquires medical records and conducts audits of physicians , independent practice groups  and hospitals  to ensure proper ICD-9 coding. Ensures that both utilization and quality programs meet criteria. Responsible for determining appropriate ICD-9 codes for medical services.  Audits for accuracy of ICD-9 coding, and compliance with established policies and procedures.  Provides training and guidance to service operations staff to educate staff the benefits of proper ICD-9 coding.   Maintains current knowledge of coding and keeps current with medical compliance and reimbursement policies impacting claims payment.  Compiles and maintains statistical data consistent with company and department guidelines and established standards.  Provides regular feedback to Operations leadership on performance improvement opportunities as a result of performance gaps and definition of root causes.  Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.  Documents and tracks intervention results and benefits to the provider.  Develops appropriate feedback templates and tools for the business.  Prepares reports to management that define and evaluate problems and propose solutions.  Assesses and identifies training opportunities.  Participates and represents the department in business leadership groups.  Participates in continuous quality improvement initiatives as appropriate.  Assists the business with research and documentation of workflows, policies and procedures and other reference materials.