Coding Quality Auditor
About The Position
Under the supervision of the Coding Manager, Revenue Capture, the HCC Coding Quality Auditor performs detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding. The auditor reviews and abstracts HCC codes to ensure accurate coding at the highest specificity, queries providers to clinically validate or clarify diagnosis criteria, and reviews documentation for compliant reporting, billing, and RVU capture. The role serves as a coding expert and works with the Quality Integrity Program manager and clinical documentation review team to support compliance with Official Coding Guidelines for Coding and Reporting, coding conventions, and regulatory oversight agencies. The position is with Providence Medical Group Northwest Washington. Providence describes its culture as patient-focused, whole-person care built on understanding, commitment, and mutual respect, and emphasizes empowering caregivers.
Requirements
- At least 2 years of experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVUs.
- Experience reviewing patient account information, insurance explanations of benefits, computer screens, and financial records.
- Within 1 year of hire, obtain Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification.
Nice To Haves
- Bachelor's degree, or equivalent education/experience.
- Within 1 year of hire, obtain Certified Risk Adjustment Coder (CRC) certification.
- Within 1 year of hire, obtain Certified Professional Medical Auditor (CPMA) or Certified Healthcare Compliance Auditor (CHCA) certification.
- Experience in HCC coding.
Responsibilities
- Review diagnostic charts and associated clinical documentation and coding for Risk Adjustment and HCC coding.
- Review and abstract HCC codes to ensure accurate coding at the highest specificity.
- Query providers to clinically validate or clarify diagnosis criteria.
- Review documentation for compliant reporting and billing and RVU capture.
- Serve as a coding expert and work with the Quality Integrity Program manager and clinical documentation review team to support compliance with official coding guidelines, conventions, and regulatory oversight.
Benefits
- Best-in-class benefits designed to support employees and their families 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
No Education Listed
