IKC Coding Auditor & Educator

DAVITA • Denver, CO

19d

About The Position

DaVita IKC is seeking a highly motivated and experienced Risk Adjustment Auditor and Educator to join our Coding team. This role is crucial for ensuring the accuracy, integrity, and compliance of our risk adjustment coding and clinical documentation related to professional services provided by both internal and external nephrology partners. The ideal candidate will serve as a subject matter expert, performing detailed medical chart audits and providing targeted education to providers and coding teams to support our commitment to high-quality patient care and adherence to all formal regulatory and coding guidelines.

Requirements

• Current coding certification from AAPC or AHIMA is required (CCA and CPC-A are not accepted).
• 3+ years of coding experience.
• 2-3 years’ minimum recent experience performing medical audits for diagnosis coding.
• Strong computer skills, including the ability to utilize various EMR systems and Microsoft Office.
• Expert knowledge of ICD-10-CM and CMS-HCC risk adjustment models.
• Deep understanding of coding and documentation compliance, including CMS and HHS regulations.
• Excellent verbal and written communication skills, with the ability to present complex information clearly.
• Strong analytical and problem-solving skills with a high degree of accuracy and attention to detail.
• Demonstrated ability to work independently and collaboratively in a fast-paced, team-oriented environment.

Nice To Haves

• Proven experience in developing and delivering education and training to clinical providers and coders is highly preferred.

Responsibilities

• Conduct retrospective, concurrent, and prospective audits of medical records to validate the accuracy of ICD-10-CM codes and ensure documentation supports submitted diagnoses for Medicare Risk Adjustment (HCC coding).
• Perform detailed internal and external coding audits on a regular basis as defined by compliance & department requirements, including for our nephrology partners.
• Execute targeted audit plans, including performing targeted audits of identified HCC outliers.
• Identify trends, patterns, and areas of opportunity for documentation and coding improvement through data analysis and audit findings.
• Prepare and present formalized audit reports to leadership, summarizing findings, identifying risk areas, and recommending corrective action plans.
• Assist in internal and external audits, including Risk Adjustment Data Validation (RADV) audits, by preparing documentation and responding to inquiries.
• Perform necessary research to provide supportive regulatory and coding guideline documentation.
• Deliver comprehensive training programs and educational materials for providers, coders, and clinical staff on risk adjustment, proper documentation, and coding guidelines.
• Provide one-on-one and group education sessions based on audit findings, tailoring content to address specific needs and knowledge gaps.
• Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions.
• Stay current with official coding guidelines from CMS, HHS, and other regulatory bodies to ensure all educational content is accurate and up-to-date.
• Maintain meticulous records of audit findings, educational sessions, and follow-up actions to ensure a clear audit trail.
• Participate in special projects related to process improvement, compliance, and coding initiatives as assigned.
• Maintain strict confidentiality of patient and proprietary information.
• Demonstrate and exemplify behavior consistent with DaVita’s core values: Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment, and Fun.

Benefits

• Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out
• Support for you and your family: Family resources, EAP counseling sessions, access Headspace®, backup child and elder care, maternity/paternity leave and more
• Professional development programs: DaVita offers a variety of programs to help strong performers grow within their career and also offers on-demand virtual leadership and development courses through DaVita’s online training platform StarLearning.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees