Professional HCC Risk Adjustment Auditor - Remote

Purpose:

The HCC Coder / Auditor is responsible for accurately abstracting data into appropriate client data systems, following the Official Guidelines for Coding and Reporting as well as Risk Adjustment guidelines for data collection. Client-specific guidelines may also contribute to the coding and validation process. This role will be responsible for reviewing a patient’s complete record and assigning ICD-10-CM codes and specifically those mapping to HCCs, for completeness and accuracy

Accountabilities:

• Meet client expected turn-a-round times for completing work.
• Must be able to meet the minimum productivity standards.
• Must meet or exceed 95% accuracy rate on quality reviews.

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:

• Ensure that the codes captured are supported by the documentation within the record and are properly coded following Medicare guidelines, ICD-10-CM guidelines as well as client specific guidelines for the project.
• Be a resource for HCC coding team members by having a deep understanding of the project and coding guidelines.
• Follow Risk Adjustment Data Abstraction Rules.
• Enter audit data into audit software or other audit report.
• Evaluate the overall quality of physician documentation for quality improvement measures.
• Communicate with client and/or providers as needed (i.e. coding clarification, missing documentation, etc.)
• Provide written feedback of audit results in the form of chart level comments, summary findings and recommendations.
• Communicate with Project Manager as needed (i.e. schedule changes, daily assignments/work volume, coding questions, etc.).
• Track and enter time accurately and timely into our timekeeping system.
• Comply with policies regarding the use and disclosure of protected health information which includes accessing and using protected health information only to the extent necessary to fulfill the above-mentioned responsibilities
• Ensure compliance with federal and state laws, regulations, and standards related to health information and coding principles.
• Other duties as assigned

Ideal candidate will possess the following:

• Must have one of the following current credentials from AAPC or AHIMA; CPC, COC, CCS-P
• HCC Risk Adjustment credential is preferred (CRC)
• Must have at least 5-7 years of HCC specific coding experience with 3-5 years of recent HCC auditing experience.
• Make corrections as needed to ensure accurate submission of HCC codes to CMS.
• Stay up to date on the hierarchies associated with both CMS and HHS defined HCCs as well as the ability to navigate between different models that are in place for defined audit initiatives
• Extensive knowledge of medical terminology.
• Experience in researching and applying coding rules and regulations.
• Experience working in an audit software tool.
• Proficiency in Microsoft Excel, Word, and various EMR (Electronic Medical Record) systems.
• Excellent oral and written communication skills.
• Excellent time management and organizational skills.
• Have a positive, respectful attitude.

CodingAID, a division of Managed Resources Inc., is an Equal Opportunity Employer (EOE) M/F/D/V/SO