Professional Auditor with HCC Risk Adjustment Experience


Industry: Coder - HCC Job Number: 2799

Job Description

Professional Auditor with HCC Risk Adjustment Experience - Remote Job Description
The primary responsibility of the Professional Auditor with HCC Risk Adjustment Experience is to audit CPT, HCPCS, ICD-10-CM, Modifiers, Units and identify documentation and coding discrepancies and improvements based on medical record documentation.

The HCC Auditor is responsible for accurately abstracting data 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 or one date of service according to the clients audit scope and assigning ICD-10-CM codes and specifically those mapping to HCCs, for completeness and accuracy.
Reports to:                   
Director of Professional Coding and Audit
  • 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:
  • Audit all E/M, CPT, HCPCS, ICD-10-CM, modifiers, units from the medical record documentation.
  • Capture all ICD-10-CM codes that Risk Adjust.
  • Enter audit data into audit software or other audit report.
  • Evaluate the overall quality of physician documentation for quality improvement measures.
  • Perform accurate coding using applicable guidelines and client protocols.
  • 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
  • HCC Risk Adjustment credential is preferred (CRC)
  • A minimum of five - seven years’ experience required auditing CPT, E&M, HCPCS and ICD-10-CM codes.
  • Minimum of five - seven years of hands-on coding/audit experience in the Risk Adjustment environment.
  • CPMA or equivalent audit credential.
  • Be a resource for HCC coding team members by having a deep understanding of the project and coding guidelines.
  • Report writing experience based on audit findings
  • Experience in provider and/or coder education and/or assist the educator on HCC trainings
  • Requires advanced technical knowledge in specific surgical and medical specialties as assigned.
  • Experience in the various Risk Adjustment models:   Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, Commercial IVA (Initial Validation Audit), and Medicare RADV (Risk Adjustment Data Validation).
  • 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

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