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The HCC Coding Quality Auditor/Educator will facilitate the development and maintenance of HCC coding and audit programs. The programs are designed to accomplish accurate risk adjustment reporting through the complete and accurate assignment of ICD-9-CM and ICD-10-CM codes corresponding to conditions that are considered part of CMS HCC model and are supported in member's medical record. The HCC Coding Quality Auditor/Educator will be responsible for reviewing provider documentation to verify that all MA risk adjustment documentation requirements are met and will deliver education to providers. The reviewed RA information for compliance and educational objectives must be in strict adherence to Official ICD-9-CM and ICD-10-CM Guidelines for Coding and Reporting, AHA Coding Clinic, CMS, and other organizational policies and procedures. The profile of the members in the HCC programs could vary from complex and high-risk patients to healthy members with Triple Aim target, which is a) enhance member experience, b) reduce costs, and c) improve health outcomes.
