[Remote] Sr Analyst, Corp Compliance

Note: The job is a remote job and is open to candidates in USA. DaVita Kidney Care is seeking a highly motivated Medicare Risk Adjustment Auditor and Educator to join their compliance team. This role focuses on ensuring the accuracy and compliance of risk adjustment coding and clinical documentation, involving detailed medical chart audits and targeted education for providers and coding teams.

Responsibilities

• 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
• 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
• 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

Skills

• Current coding certification from AAPC or AHIMA is required (CCA and CPC-A are not accepted)
• 3+ years of coding experience
• 2-3 years' minimum recent experience performing medical audits for diagnosis coding
• 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
• High school diploma or equivalent required
• Basic computer skills and proficiency in MS Word, Excel, and Outlook required
• Proven experience in developing and delivering education and training to clinical providers and coders is highly preferred
• Minimum of three (3) years' healthcare reimbursement experience preferred
• Experience with admissions, billing, and collections preferred
• Demonstrated knowledge of insurance rules, regulations and Coordination of Benefits for federal, state, and managed care payors in multiple states preferred

Benefits

• 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.

Company Overview

• DaVita means “to give life,” reflecting our proud history as leaders in dialysis—an essential, life-sustaining treatment for those living with end stage kidney disease (ESKD). It was founded in 1979, and is headquartered in Denver, Colorado, USA, with a workforce of 10001+ employees. Its website is http://www.davita.com.

Company H1B Sponsorship

• DaVita Kidney Care has a track record of offering H1B sponsorships, with 63 in 2025, 54 in 2024, 81 in 2023, 74 in 2022, 54 in 2021, 66 in 2020. Please note that this does not guarantee sponsorship for this specific role.

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