Coding Data Quality Auditor

• Perform audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures
• Support coding judgment and decisions using industry standard evidence and tools
• Abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting
• Establish medical necessity
• Identify clinically active vs. historical conditions
• Ensure diagnosis codes are appropriate, accurate, and supported by clinical documentation
• Utilize medical records to ensure support is documented for etiology and manifestations of disease processes
• Adhere to stringent timelines consistent with project deadlines and directives
• Conduct self- process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body

• Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing
• Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 1-2 years for CPC
• CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required
• CRC (Certified Risk Adjustment Coder) or obtain within 6 months
• Computer proficiency including experience with Microsoft Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications)
• Experience with International Classification of Disease (ICD) codes required
• Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred
• AA/AS or equivalent experience

Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access