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 risk adjustment processes
• 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
• Ensure diagnosis codes are appropriate, accurate, and supported by clinical documentation in accordance with all State and Federal regulations and internal policies and procedures
• Identify clinically active vs. historical conditions
• 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
• AA/AS or equivalent experience
• 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)
• 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

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

• Affordable medical plan options
• 401(k) plan with matching company contributions
• Employee stock purchase plan
• 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