Coding Auditor
Posted 2 weeks ago by 1759913301
Negotiable
Outside
Remote
USA
Summary: The Coding Auditor role involves providing quality assurance and coding audit services for risk adjustment in ACA Commercial, Medicare, and Medicaid programs. The position requires reviewing patient records for compliance, conducting audits on coding accuracy, and understanding hierarchical condition categories. The role is remote and focuses on ensuring adherence to coding guidelines and regulations. Candidates must possess relevant experience and coding certification.
Key Responsibilities:
- Review patient records for compliance with documentation standards.
- Conduct audits on abstracted files for coding accuracy and completeness.
- Identify coding opportunities and ensure adherence to coding guidelines.
- Understand hierarchical condition categories and participate in quality coding initiatives.
Key Skills:
- Associate degree and 3 years of relevant medical coding experience, or 5 years of relevant experience in lieu of a degree.
- Proficient knowledge of CMS-HCC model and guidelines.
- Previous experience in auditing medical records.
- Coding Certification (CRC, RHIA, RHIT or similar) in good standing.
- ICD-10 proficiency.
Salary (Rate): undetermined
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Other
Detailed Description From Employer:
Job position: Coding Auditor
Location: Remote
Duration: 9+ Months
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 Experience
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 Experience
Bachelor s Degree
Experience with NLP/AI coding software
Risk Adjustment methodology experience
Specialty coding experience