Risk Adjustment Coding Auditor II (AAPC or AHIMA coding certification required)

CareSource • Dayton, OH

2d

About The Position

The Risk Adjustment Coding Auditor II is responsible for performing over-reads of vendor ICD-10 coding, reviewing provider documentation supplied to them, and diagnostic codes assigned by vendor. The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.

Requirements

• High School Diploma or GED is required
• Minimum of three (3) years of diagnostic coding experience and a firm understanding of ICD-10 is required
• A minimum of three (3) years of experience in auditing medical records is required
• Risk Adjustment methodology experience required
• Intermediate level with Microsoft Word, Microsoft Outlook, Microsoft Excel
• Ability to work in a fast paced production environment while maintaining high quality
• Knowledgeable and experienced with researching CMS and other sites for Risk Adjustment guidance
• Exceptional knowledge of medical coding and regulatory requirements
• Knowledgeable of Medicaid, Medicare, Exchange
• Knowledgeable of ICD-10
• Ability to make independent decisions on ICD 10 code assignments
• Excellent verbal and written communication skills
• Ability to effectively interface with teammates, vendors and management
• Ability to work with others and work independently
• Possesses critical thinking/listening skills
• Strong interpersonal skills and high level or professionalism
• Detail oriented
• AAPC or AHIMA coding certification is required

Nice To Haves

• Facets training/knowledge is preferred

Responsibilities

• Meets assigned volume metrics
• Validates the accurateness of ICD-10 codes assigned by the vendor
• Tracks the trends and reports on the findings
• Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products
• Participates in quality coding initiatives as appropriate or assigned
• Maintains knowledge of AHA Coding Clinic and ICD-10 Official Guidelines for Coding and Reporting
• May be asked to perform over reads of provider coding/documentation
• Meets deadlines and works independently on multiple projects
• Perform any other job duties as requested

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees