American Choice Healthcare ยท 2 weeks ago
Auditor, ACO Coding
Miami, FL
Full-time
Hybrid
Mid Level
3+ years expAmerican Choice Healthcare is committed to building the best primary care environment for patients and is seeking healthcare enthusiasts to join their team. The ACO Coding Auditor will review medical records and ensure compliance with Medicare Risk Adjustment requirements while providing guidance to healthcare practices.
Hospital & Health Care
Responsibilities
Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with the physician
Provides guidance and consultation to practice team members to drive improved MRA coding proficiency over time
Verifies and ensures the accuracy, completeness, specificity, and appropriate coding based on CMS HCC categories
Analyzes and translates medical and clinical diagnoses, procedures, and illnesses into Medicare Risk codes
Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries
Represent the Quality department with tracking open gaps to ensure HEDIS standards are meet as follow but not limited to: Part-D & Medication Adherence, Part-C & Preventive Care measures, Patient Experience and Audit Process
Engage with practice management team members on applying correct steps into daily process including and no limited to module software on an ongoing basis
Support affiliate medical centers to increase uniformity on the generalization of daily process where Quality data is collected
Participates in audits and analyzes data to identify trends and improvement opportunities
Performs ongoing analysis of medical charts to ensure all codes are reported timely and properly to CMS
Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to Medicare coding and documentation guidelines
Facilitates education and/or educates providers and office staff on proper CMS Risk Adjustment coding, billing, pay for performance measurements and medical record review criteria
Communicates with co-workers, management, and practice staff regarding documentation, claim submission and reimbursement issues
Provides support and compliance through effective communication and training/education
Participates in departmental and organizational quality management activities
Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives
Attends departmental meetings as required
Effectively manage special projects and other tasks as assigned
Document and trend findings in identified database
Any other duties or responsibilities assigned
Qualification
Required
High School diploma or GED required
Required Certified Coder; CPC, CRC, CCS-P, CCS-H, RHIT
3+ years of Medicare Risk Adjustment experience
Experience working in health care and insurance Industry
Ability to travel both locally and across the United States
Proficient in ICD-10 coding and strong knowledge of ICD-9 and CPT coding
Ability to evaluate medical records with attention to detail
Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision
Must be a reliable team player committed to working in a quality and customer centric environment. Will require daily interaction in person, on the phone, and via email
Superior customer service skills: demonstrate responsiveness, depth of knowledge and thoroughness in handling and responding to inquiries from patients and team members
Base knowledge of clinical standards of care and preventive health standards
Strong organizational skills and ability to work both independently and with teams
Ability to make formal presentations in front of committee and work group environments as needed
Ability to use databases and prepare reports as needed
Proficiency in Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Excellent verbal and written communication skills
Company
American Choice Healthcare
American Choice Healthcare (ACH), an ACO REACH entity, financially rewards practices for achieving great patient outcomes and managing healthcare costs for Medicare Fee-for-Service (FFS) patients.
11-50 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase