Coding Auditor

AllCare Management Services•Grants Pass, OR

13h

About The Position

This position is responsible for the development, implementation, and maintenance of auditing practices related to medical record coding and documentation, with the objective of capturing accurate and complete risk adjustment outcomes for Medicare members leading to an increased level of care. The risk adjustment coder ensures that member medical records are following the Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation procedures by performing the following duties.

Requirements

May require the use of a personal cell phone (cell phone stipend applicable).
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.
High school diploma or general education degree (GED) required. One-year certificate from college or technical school in CRC preferred.
Two to four years related experience in coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC).
Certified Risk Adjustment Coder (CRC) or willing to be certified within 1 year of hire.
Proficient in facility coding (OPPS/IPPS) and RADV audits
Strong understanding of the healthcare industry and HIPAA compliance
Skilled in Microsoft Office Suite and learning management systems
Knowledgeable in operating systems, programming languages, and software technologies
Experienced in data interpretation, pay equity assessments, and compensation analysis
Exceptional writing, editing, and proofreading skills
Professional and empathetic communication with diverse teams and customers
Skilled in conflict resolution, negotiation, and building trust
Able to collaborate effectively in multidisciplinary and multicultural environments
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.
Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Nice To Haves

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage you to apply if you are bilingual.

Responsibilities

Ensuring the accuracy and correlation of diagnosis codes, dates of service, and chart notes.
Identifying and communicating trends related to coding and documentation quality.
Formulating intervention strategies for healthcare providers.
Data analysis is performed to generate reporting packages that serve both internal purposes and external risk adjustment requirements.
Chart data are meticulously reviewed to ensure accurate Hierarchical Condition Category (HCC) coding, accompanied by informed recommendations for providers.
Reviews medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog and larger chart page counts.
Work que is addressed with goal to clear within 72 hours.
Updates and maintains training course material for medical record abstraction and data entry (HEDIS, RISK, IVA).
Maintains an accuracy score of 95% on all work submitted (all projects).
Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and/or attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
Audit reports are meticulously developed, with findings presented to providers in a clear and constructive manner.
Assistance is provided on complex internal audits, guided by established management directives, while adhering to auditing standards and professional practices and respecting defined schedules and deadlines.
Support the HEDIS Medical Chart Auditor.
Support Compliance with medical chart audits against claims.
Data is collected, organized, and disseminated effectively among both external and internal stakeholders, incorporating recognized best practices for process improvement.
Conducts and facilitates prospective, retrospective, and concurrent reviews.
Assists in the development and presentation of corrective action plans to providers where weaknesses in control have been identified and conducts ongoing monitoring until remediation solutions are resolved.
Collects, organizes, and shares data with external and internal stakeholders, including process improvement best practices.
Various documents and reports are prepared as required.
Collaborate with the Provider Engagement team for provider outreach to enhance provider/clinic experience through best practices and utilizing analytics
Monitors and adheres to compliance standards, including HIPAA regulations and organizational policies.
Stays updated on changes in coding guidelines, payer regulations, and CMS policies.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes direction from leadership.
Meets all required training including those listed in Relias Learning Module System (LMS).
Performs other duties as assigned.