Risk Adjustment Auditor (1.0 D)
About The Position
As a MARSI (Medical Audit, Recovery & Strategic Health Initiative) certified auditor, it will be critical to review medical records to accurately identify diagnosis and codes based on pre-visit services. The auditor role will be reviewing HCC and RAF problem lists on a pre-visit basis, and review HCC gaps for the year. This individual will, also, provide solutions to increase provider documentation and capture diagnosis codes that weren’t captured during the visit. It is important for all members of the clinical team to be aware of those patients who have an HCC Gap to alert their provider, and ensure that these patients have a scheduled follow-up appointment with their attributed primary care physician/NP/PA. WHO WE ARE Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers who provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries. Assist with validation audits to evaluate medical record documentation, to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code. Submit documentation to CMS for reimbursement and interpretation of medical documentation, to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Attention to detail while reviewing patient’s clinical record. Ensure regulatory compliance, and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC.
Requirements
- Associate's Degree, LPN/RN - Associates Degree - Required or Certificate, Medical Assisting - Required
- 3 years experience in the Medical Field - Required
- Certified Medical Assistant (CMA) - American Association of Medical Assistants (AAMA) - Required or Licensed Practical Nurse (LPN) - State Licensing Board - Required or Registered Nurse (RN) - State Licensing Board - Required
Nice To Haves
- 1 year Coding experience - Preferred
Responsibilities
- Review medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries.
- Assist with validation audits to evaluate medical record documentation, to ensure coding accurately reflects and supports relevant coding based on the ICD-10 code.
- Submit documentation to CMS for reimbursement and interpretation of medical documentation, to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
- Attention to detail while reviewing patient’s clinical record.
- Ensure regulatory compliance, and overall quality and efficiency by utilizing strong working knowledge of coding standards and EPIC.
Benefits
- Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
