HCC Coding Auditor Senior - Health Plan Admin

Description

Summary :

HCC Coding Auditor Senior will perform code audits andabstraction using the Official Coding Guidelines for ICD-10-CM, AHACoding Clinic Guidance, and in accordance with all stateregulations, federal regulations, internal policies, and internalprocedures.

The HCC Coding Auditor Senior will be involved withactivities of quality assurance auditing and risk adjustment codeabstraction for the following programs : including but not limitedto, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment,and HHS and Medicare RADV (Risk Adjustment Data Validation).

Thisis an onsite position with a remote option.

Responsibilities :

Perform Medical Record reviews and audits basedon organizational priorities. These can include both prospectiveand concurrent Clinical Documentation Improvement (CDI) workflowsas well as retrospective auditing.

Review and audits may lead tothe addition, deletion, adjustment, or confirmation of diagnosesfor risk adjustment.

• Perform code abstractionand / or coding quality audits of medical records to ensure ICD-10-CMcodes are accurately assigned and supported by clinicaldocumentation to ensure adherence with CMS (HCC) Risk Adjustmentguidelines.
• Perform coding quality auditswithin multiple EMRs, databases, and / or vendor platforms to supportboth employed and independent clinic risk adjustmentstrategies.
• Identifies revenue, reimbursement,and provider educational opportunities while remaining compliantwith state and federal regulations.
• Prepareand / or perform auditing analysis and provide feedback onnoncompliance issues detected throughauditing.
• Complies with all aspects of coding,abides by all ethical standards, and adheres to official codingguidelines.
• Conduct provider education andtraining regarding risk adjustment to help ensure accurate CMSpayment and to improve the quality of care.

This includes trainingvenues such as provider offices, hospitals, webinars, conferencecalls, email correspondence, etc.

• Providesmeasurable, actionable solutions to providers that will result inimproved accuracy for documentation and coding practices to ensurechronic conditions are recaptured annually
• Ensures that rendered physician services forclaim submission and any subsequent payments are as accurate aspossible while complying with regulatory guidelines including CMS,DHS, and OIG
• Assist coding leadership by makingrecommendations for process improvements to further enhance codingquality goals and outcomes
• Provides measurable,actionable solutions to providers that will result in improvedaccuracy for documentation and coding practices to ensure chronicconditions are recaptured annually
• Responsiblefor maintaining current knowledge of coding guidelines and relevantfederal regulations through the use of current ICD-10-CM manual andother relevant material

Requirements :

• High School Diploma required orequivalent
• Excellent written and verbalcommunication skills.
• Ability to drive withinassigned areas or overnight travel for internal or externalmeetings.
• Capacity to attend remote providermeetings day / evening / weekends as needed within assigned regions asdefined by manager / leadership.
• At least three(3) years of hospital inpatient / outpatient or medical office codingexperience, preferably three (3) years risk adjustment codingexperience.
• Prior experience teaching / trainingothers on correct coding guidelines and have the ability to presentto large groups of Physicians / Providers.
• Coding certification required through AHIMA or AAPC (at least twoof the below) :
• Certified Professional Coder(CPC) required
• Certified Risk Adjustment Coder(CRC) required
• Certified Coding Specialist forProviders (CCS-P) preferred
• Registered HealthInformation Management Technician (RHIT)preferred
• Certified Coding Specialist forProviders (CPMA) preferred
• Certified CodingSpecialist for Providers (CDEO) preferred

Work Type : Full Time

Full Time

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