Coding Auditor - (CRC) - remote

Summary: This role of Coding Auditor involves providing quality assurance and coding audit services specifically for risk adjustment in ACA Commercial, Medicare, and Medicaid programs. The position requires reviewing patient records to ensure compliance with coding standards and conducting audits to verify the accuracy of coding practices. The role is remote and emphasizes the importance of understanding hierarchical condition categories and coding guidelines.

Key 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.

• 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.

• Bachelor's Degree.
• Experience with NLP/AI coding software.
• Risk Adjustment methodology experience.
• Specialty coding experience.

Salary (Rate): undetermined

City: undetermined

Country: USA

Working Arrangements: remote

IR35 Status: outside IR35

Seniority Level: undetermined

Industry: Other