Responsible for analyzing and reviewing medical records to ensure compliance with CMS Guidelines. Provides support during internal or external audit procedures.Essential Functions:- Evaluate and analyze medical records to ensure that all documentation is correctly codified in accordance with CMS and industry guidelines.- Contact providers to request or collect medical records at their medical office.Identify gaps and trends in the medical record’s documentation and refers for escalation process any issue found with the provider.- Prepare reports, summaries and action plans based on the analysis performed on Microsoft Excel and Power Point and present it to Management.- Review and act on any assigned audit educational opportunities timely and provide training as necessary to educate on audit findings to physicians and medical office staff.- Attend risk adjustment and quality provider meetings for assigned provider groups to offer updates, recommendations, or education (may occur be before/after normal business hours).- Identify risk adjustment audit trends in the industry for discussion and development of possible analysis.- Provides support to audits requested by CMS, OIG, and Compliance or Internal Audit - Department by reviewing medical records, determine the completeness, coding and prepare the records for submission.- Performs quality audits to our vendors and provides recommendations and action plans to work with any deficiency found.- Understands, develops, tracks, monitors, and reports on key program performance metrics for coding initiatives.- Meet the metrics established by the department and comply with the policies and procedures of the department.- Assure compliance by delivering quality services and meeting all contractual, state & federal legal and regulatory requirements.- Maintain current knowledge of coding guidelines and relevant federal regulations using current ICD-10 CM, CPT, HCPCS.Bachelor’s Degree in Business Administration with one (1) to three (3) years of Finance or Accounting experience, preferable with health insurance industry. Or Bachelor’s Degree in Healthcare or related field with one (1) to three (3) years in the insurance and health industry. Certified Coder, CPC or CRC Preferred