Risk Adjustment Coding Auditor, Sr

CareOregon

1d • $81,000 - $99,000 • Remote

About The Position

The Coding Auditor, Senior performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department. Estimated Hiring Range: $81,000.00 - $99,000.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job.

Requirements

• Minimum 5 years’ experience as certified coder
• Current coding certification from AHIMA or AAPC
• One-year experience with risk adjustment program in a Health Plan (applies to roles in Finance/Risk Adjustment department)
• Extensive knowledge of diagnosis coding conventions as defined by CMS and AMA
• Expert knowledge of risk adjustment principles for CMS and/or CDPS+RX (applies to roles in Finance/Risk Adjustment department)
• Ability to read and comprehend medical terminology and medical chart notes
• Ability to work proficiently with electronic health record (EHR) software systems
• Strong computer skills, including ability to learn new systems and applications as needed
• Strong skill and ability to use Microsoft office products (PowerPoint, Excel, Word, etc.)
• Analytical, problem-solving and research skills
• Proficient written and spoken communication skills
• Ability to effectively teach and coach adult learners and communicate technical information clearly
• Ability to present information to groups, including medical professionals
• Strong attention to detail and problem-solving skills
• Ability to work autonomously with a high degree of initiative
• Ability to work well under pressure, remain focused and meet deadlines
• Ability to use good judgment and discretion to perform job responsibilities
• Ability to adhere to organizational standards, policies and procedures
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Nice To Haves

• Certified Risk Adjustment Coder (CRC), Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO)
• Experience leading group educational presentations and teaching to medical professionals
• 5 years’ experience with CMS, HHS and/or CDPS+RX Hierarchical Condition Categories (HCC) models (applies to roles in Finance/Risk Adjustment department)
• Experience with or knowledge of risk adjustment principles (applies to roles in Finance/Risk Adjustment department)
• Ability to use SAS, SQL, Tableau or other analytic software (helpful, but not required)

Responsibilities

• Perform and lead a variety of coding-related audits for providers and other entities.
• Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data.
• Communicate audit results and recommendations for improvement to providers when needed.
• Create and maintain processes for tracking audit results and outcomes of reviews.
• Identify, track, analyze and report on any trends revealed in audits.
• Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders.
• Lead the development of educational materials and process documentation in a variety of mediums (e.g., recorded training sessions, reference documentation, etc.).
• Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations by frequently referencing current ICD-10-CM and CMS manuals, reviewing professional publications, and attending educational workshops/conferences.
• Maintain active coding certification.
• Seek out emerging coding best practices using a variety of strategies (e.g., establishing personal networks, participating in professional associations, etc.).
• Serve as subject matter expert regarding correct coding practices.
• Work with Risk Adjustment team to create Standard Operating Procedures (SOPs), process flows and contribute to roadmaps for future state Risk Adjustment Coding initiatives.
• Onboard and train new Coding Auditors.
• Oversee and audit Coding Auditor coding results; providing feedback and retraining, as needed.
• Lead Risk Adjustment Data Validation RADV and other diagnosis code related audits (applies to Finance department roles only).
• Perform and lead a variety of coding-related audits for providers and other entities including activities of quality assurance auditing and risk adjustment code abstraction for the following programs: including Medicare Advantage Risk. Adjustment and CDPS+RX in accordance with all state regulations, federal regulations, internal policies, and internal procedures.
• Perform Retrospective and Concurrent chart reviews to ensure accurate risk adjustment reporting.
• Verify and ensure the accuracy, completeness, specificity and appropriateness of provider-reported diagnosis codes based on medical record documentation. This includes applicable vendor reported diagnosis codes.
• Review medical record information to identify complete and accurate diagnosis code capture based on CMS HCC categories.
• Serve as a risk adjustment coding resource and subject matter expert, offering guidance and clarification on coding and compliance questions.

Benefits

• CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.).
• We also offer a strong retirement plan with employer contributions.
• Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state.
• Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility.
• Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed