Hcc coding auditor senior - hp network documentation integration Job at CHRISTUS Health (Irving)

Job Description

Coding Auditor Senior will perform code audits and abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The Coding Auditor Senior will be involved with activities of quality assurance auditing and risk adjustment code abstraction for the following programs, including but not limited to Commercial Risk Adjustment, Medicare Advantage Risk Adjustment, and HHS and Medicare RADV (Risk Adjustment Data Validation).

Job Responsibility

Perform Medical Record reviews and audits based on organizational priorities. These can include both prospective and concurrent Clinical Documentation Improvement (CDI) workflows as well as retrospective auditing. Review and audits may lead to the addition, deletion, adjustment, or confirmation of diagnoses for risk adjustment
Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS (HCC) Risk Adjustment guidelines
Perform coding quality audits within multiple EMRs, databases, and/or vendor platforms to support both employed and independent clinic risk adjustment strategies
Identifies revenue, reimbursement, and provider educational opportunities while remaining compliant with state and federal regulations
Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines
Conduct provider education and training regarding risk adjustment to help to ensure accurate CMS payment and to improve quality of care. This includes training venues such as provider offices, hospitals, webinars, conference calls, email correspondence, etc.
Provides measurable, actionable solutions to providers that will result in improved accuracy for documentation and coding practices to ensure chronic conditions are recaptured annually
Ensures that rendered physician services for claim submission and any subsequent payments are as accurate as possible while complying with regulatory guidelines including CMS, DHS, and OIG
Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current ICD-10-CM manual and other relevant material

Requirements

High School Diploma required or equivalent
Excellent written and verbal communication skills
Ability to drive within assigned areas or overnight travel for internal or external meetings
Capacity to attend remote provider meetings day/evening/weekends as needed within assigned regions as defined by manager/leadership
At least three (3) years of hospital inpatient/outpatient or medical office coding experience, preferably three (3) years risk adjustment coding experience
Prior experience teaching/training others on correct coding guidelines and have the ability to present to large groups of Physicians/Providers
Coding certification required through AHIMA or AAPC (at least two of the below): Certified Professional Coder (CPC) required
Certified Risk Adjustment Coder (CRC) preferred
Certified Coding Specialist for Providers (CCS-P) preferred
Registered Health Information Management Technician (RHIT) preferred
Certified Coding Specialist for Providers (CPMA) preferred
Certified Coding Specialist for Providers (CDEO) preferred

Nice to have

Certified Risk Adjustment Coder (CRC)
Certified Coding Specialist for Providers (CCS-P)
Registered Health Information Management Technician (RHIT)
Certified Coding Specialist for Providers (CPMA)
Certified Coding Specialist for Providers (CDEO)

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Hcc coding auditor senior - hp network documentation integration

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