HCC Risk Adjustment Coder I

Regal Medical Group • Los Angeles, CA

80d • $25 - $27

About The Position

The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services.

Requirements

• Requires knowledge in HCC Coding documentation guidelines.
• Requires technical expertise in ICD-9-CM or ICD-10-CM.
• Strong skills in medical record audit and review.
• Regulatory requirements for coded data.
• Medical record documentation requirements.
• Understanding of healthcare data systems.
• Proficiency in MS Outlook and Word.
• Strong proficiency with Excel--must have ability to prepare spreadsheets.
• Excellent written and verbal communication skills.
• Certification is a plus with HCC.
• AHA coding clinic is a plus.
• Certification required in CPC and/or CCS, and CRC is a plus.

Responsibilities

• Works as an integral member of the Finance Department.
• Code review super bills and patient medical records for proper use of diagnosis and procedure codes.
• Interface effectively with physicians and office staff on coding issues.
• Research coding questions as needed.
• Code review a wide variety of document types, i.e., Primary and specialty care medical records, mental health, substance abuse, in-patient, out-patient, non-submittals (lab), ancillary, and pharmaceutical services for HCC values.
• Perform both provider office audits and online audits by reviewing patient medical records.
• Provide education to the provider and staff on office audit findings.
• Communicate best coding practices.
• Consistently meet productivity and quality standards as outlined by the supervisor.
• Generate MS Excel spreadsheets for various projects with the primary focus on tracking activities.
• Make internal and external phone calls to other departments and provider offices as needed.
• Learn software programs essential to the HCC department, such as iCode, EZCap, and Access Express.
• Upload medical records via our internal software program iCode.
• Research and correspond with our providers to obtain correct diagnosis coding as generated from internal and external error reports.
• Present educational material to providers.
• Perform photocopy services.
• Perform scanning services.
• Perform faxing services.
• All other duties as directed by management.

Benefits

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services
• 401(k) Retirement Savings Plan
• Income Protection Insurance
• Vacation Time
• Company celebrations
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

What This Job Offers

• Job Type: Full-time
• Number of Employees: 1,001-5,000 employees