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Anthem, Inc Compliance Consultant Sr. (Medical Coding Certification Required)-PS26583 in San Diego, California

Compliance Consultant Sr. (Medical Coding Certification Required)-PS26583

Location: Columbus, Ohio, United States


Requisition #: PS26583

Post Date: 3 days ago

Your Talent. Our Vision . At Anthem, Inc. , it’s a powerful combination, and the foundation upon which we’re creating greater 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.

Compliance Consultant Sr. (Medicare Risk Adjustment: Medical Records Auditor & Training Consultant)

Location: Preferred location is Columbus , Ohio, however, the selected candidate may be in any Anthem office location or work remotely.

The Compliance Consultant Sr. performs audits by evaluating medical records to ensure risk mitigation and to ensure compliance with CMS, ICD-10-CM coding guidelines, and medical record documentation requirements. This position is also responsible for developing, reviewing, and/or presenting coding training materials where appropriate. Primary duties include:

  • Review of Medicare Advantage member medical record documentation

  • Collection and analysis of data to formulate recommendations and solutions based on audit trends and results.

  • Provides regular feedback to leadership on performance improvement opportunities as a result of performance gaps.

  • Serves as coding subject matter expert to internal and external stakeholders

  • Creates educational materials on documentation & coding for Medicare Risk Adjustment purposes

  • Provides education on coding for Medicare Risk Adjustment purposes through publications, presentations, etc.

  • Assists the business with documentation of workflows and appropriate policies and procedures.


  • Requires a BA/BS, atleast 5 years of health care, regulatory, ethics, compliance or privacyexperience; or any combination of education and experience, which would providean equivalent background. Ability to travel may be required.

  • Requires a codingcertification ( e.g., Certified Coding Associate or CertifiedProfessional Coder) from an accredited source ( e.g., AmericanHealth Information Management Association or American Academy of ProfessionalCoders).

  • Musthave experience and be comfortable conducting training or presentations to asmall, medium, and large audience via web conference or face-to-face setting.

  • CertifiedRisk Adjustment Coder – a plus.

  • 5+years of experience of relevant coding and/or medical record auditexperience. Audit experience can be in a physician’s office, hospital orinsurance office setting.

  • Experiencedeveloping educational materials is preferred.

  • MedicareRisk Adjustment experience preferred.

  • Proficientwith MS Office applications: Word, PowerPoint, Excel preferred.