Coding Auditor (quality assurance and coding audit) - 100% Remote

JOB DESCRIPTION:

Experience: 5 - 7 years

Coding Auditor

This 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 mortality

• Conduct 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 articulate.

Required 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 guidelines

• Previous experience in auditing medical records

• Coding Certification required (CRC, RHIA, RHIT or similar) in good standing.

• ICD-10 proficient.

Preferred Skills and Experiences:

• Bachelor s Degree.

• Experience with NLP/AI coding software.

• Risk Adjustment methodology experience.

• Specialty coding experience.