Coding Quality Auditor - Revenue Cycle
About The Position
Under the supervision of the Quality Integrity program, Manager, the HCC Coding Quality Auditor is responsible for detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding. The incumbent reviews and abstracts HCC codes to ensure they are coded accurately, to the highest specificity, queries providers to clinically validate or clarify diagnosis criteria, and reviews for compliant documentation resulting in compliant reporting/billing and RVU capture. Serves as a coding expert, working with the Quality Integrity Program manager and clinical documentation review team to ensure compliance with Official Coding Guidelines for Coding and Reporting, coding conventions and regulatory oversight agencies. This includes the identification and researching of provider diagnostic coding concerns, documentation compliance standards, and performing education related to provider coding errors. The incumbent supports the mission and core values of PacMed through responsible and effective work performance. Providence caregivers are not simply valued – they’re invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Requirements
- Coding Certification (Facility Managed)
- 3 years Experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU’s.
- Experienced in reviewing patient account information, insurance explanation of benefits, computer screens, and financial records.
Nice To Haves
- Associate's Degree.
Responsibilities
- Perform detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding.
- Review and abstract HCC codes to ensure accurate coding to the highest specificity.
- Query providers to clinically validate or clarify diagnosis criteria.
- Review for compliant documentation resulting in compliant reporting/billing and RVU capture.
- Serve as a coding expert, working with the Quality Integrity Program manager and clinical documentation review team to ensure compliance with Official Coding Guidelines for Coding and Reporting, coding conventions and regulatory oversight agencies.
- Identify and research provider diagnostic coding concerns and documentation compliance standards.
- Perform education related to provider coding errors.
- Support the mission and core values of PacMed through responsible and effective work performance.
Benefits
- Best-in-class benefits uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
