Job Details

Job Summary and Responsibilities

As the Risk Adjustment Audit and Compliance Specialist, you will conduct audits to measure operational risk, establishe processes to gather feedback from providers and inform and/or perform provider educational outreach, and ensure adherence to regulatory requirements. The Risk Adjustment Audit and Compliance Specialist will work closely with team members across the Quality and Risk Population Health Services Organization (PHSO) function, specifically the Value-based Coders and the Risk Adjustment Coding and Training Specialist, to ensure the risk adjustment coding process is accurate and compliant with national and local regulations. This role also collaborates with Value Hub Network Operations and Quality & Risk teams to inform local provider engagement and may require travel to provider locations. The role reports directly to the Risk Adjustment Population Health Director and plays a critical role in optimizing the overall risk adjustment process, enhancing compliance, and ensuring financial stability and profitability of the PHSO value-based operations and programs.

• Conduct operational risk audits to identify and mitigate potential risks within the risk adjustment process
• Perform audits of external vendors involved in the risk adjustment process to ensure compliance with contractual obligations and regulatory requirements
• Prepare detailed audit reports, summarizing findings, trends, and recommendations for improvement as needed
• Stay up to date with the latest laws, regulations, and industry standards affecting the risk adjustment process
• Serve as a point of contact for external auditors and regulatory bodies
• Analyze data to identify trends, patterns, and areas of concern related to risk and compliance; conduct a report out on findings to Quality & Risk leadership

***This position is remote.

Job Requirements

Minimum Qualifications:

- 3-5 years of experience with risk adjustment coding, compliance, and or auditing

- Bachelor's degree or equivalent experience in related field
- CPC or CRC Certification
- Strong understanding of ICD-10 coding and HCCs
- Experience working in a value-based care environment
- Extensive knowledge of Microsoft Office applications; Excel, Word, Outlook, PowerPoint, and Google applications

Preferred Qualifications:

- Certified Professional Medical Auditor (CPMA) certification preferred
- Experience in developing and delivering training programs in a healthcare setting preferred

Where You'll Work

The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first.

Dignity Health MSO offers an outstanding Total Rewards package that integrates competitive pay with a state-of-the-art, flexible Health & Welfare benefits package. Our cafeteria-style benefit program gives employees the ability to choose the benefits they want from a variety of options, including medical, dental and vision plans, for the employee and their dependents, Health Spending Account (HSA), Life Insurance and Long Term Disability. We also offer a 401k retirement plan with a generous employer-match. Other benefits include Paid Time Off and Sick Leave.

One Community. One Mission. One California