Coding Auditor
: Job Details :

JOB DESCRIPTIONThis position is responsible for providing quality assurance and coding audit services for risk adjustment purposes, supporting ACA Commercial, Medicare and Medicaid programs.Your Responsibilities:Reviews patient records in accordance to current compliance policies to analyze provider documentation to ensure that it meets standards and supports the diagnosis and procedure codes selected, including supporting medical necessity severity of illness and risk of mortalityConduct audits on abstracted files to ensure accuracy and completeness of coding by identifying accurate coding opportunities and rechecking all diagnoses and procedures using ICD-CM (ICD-9 and ICD-10) and CPT-4 codes to ensure adherence to all official coding guidelines, federal and state regulations, health system and departmental policies and productivity standards.Demonstrates an understanding of hierarchical condition categories (HCCs) and participates in quality coding initiatives as appropriate or assigned.Ability to articulateRequired Skills and Experiences:Assoc degree and 3 yrs relevant health plan or provider office medical coding. In lieu of degree, 5 yrs relevant experience.Proficient knowledge of CMS-HCC model and guidelinesPrevious experience in auditing medical recordsCoding Certification required (CRC, RHIA, RHIT or similar) in good standingICD-10 proficientPreferred Skills and Experiences:Bachelor's DegreeExperience with NLP/AI coding softwareRisk Adjustment methodology experienceSpecialty coding experience