Provisions Group · 1 day ago
HCC Auditor
San Antonio, Texas Metropolitan Area
Full-time
Hybrid
Mid Level
3+ years expProvisions Group is seeking an HCC Auditor responsible for performing chart reviews and data validation to improve the department’s RAF score goals and maximize revenue. The role involves reviewing electronic medical charts, conducting physician queries, and assisting in identifying coding opportunities while supporting the management team in audits.
Health CareInformation TechnologyStaffing Agency
No H1B
U.S. Citizen OnlyHiring Manager
Jack Singley
Responsibilities
Conduct both prospective and retrospective chart review audits on outpatient medical chart notes to ensure the accuracy and completeness of documentation that reflects accurate coding selection per ICD-10 CM guidelines/reporting, which substantiates HCC codes captured and submitted to CMS for reimbursement
Review medical record information to identify and assess accurate coding based on CMS- HCC categories and abstract HCC data from provider chart notes if not captured or submitted via encounter/claim data submission during CMS sweep periods
Assist with the concurrent chart review process and perform physician queries for coding and documentation clarification following physician query policy and procedure standards
Maintain a tracking and management tool for assigned medical record review projects
Meet and maintain productivity and quality metrics as defined and required by QA policy
Participate in Health Plan’s RACCR audits, CMS Risk Adjustment Data Validation (RADV) audits as needed
Assist the management team in selecting “best medical records” that validate and support HCC codes
When necessary assists the Director of HCC coding with post-chart review audit finding reports
Stay abreast with state, federal rules, regulations, and ICD-CM coding guidelines
Attend Optum coding/documentation webinars and or other coding source learning opportunity webinars on a monthly basis such as AHIMA, AAPC, etc
Follow HIPAA protocol and comply with state and federal regulations
Additional duties or project may be assigned by management team as needed
Qualification
Required
Must possess a minimum of 3 years of coding experience and at least 1 year of HCC/risk adjustment coding experience required with emphasis in the managed care environment or healthcare plan
Up to 1 +years of auditing experience and extensive knowledge in Medicare HCC coding protocol required
Prior work experience in the healthcare field with emphasis on coding and auditing of medical charts is required
Ability to work in a fast-paced production environment while maintaining high quality
Must be able to follow instructions, meet deadlines given and work independently
Ability to identify HCC improvement opportunities and provide feedback to physicians on proper clinical documentation, HCC compliance, and coding guidelines
High School diploma; and/or relevant equivalent and relevant work experience required; AA degree or Bachelor's degree in a related field preferred
Active Certifications through AHIMA and/or AAPC: Certified Professional Coder (CPC); Certified Coding Specialist (CCS); Physician (CCS-P); Registered Health Information Technician (RHIT); and Certified Risk Adjustment Coder (CRC) preferred
Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding, medical terminology, abbreviation, anatomy and physiology, major disease process, and pharmacology
Familiar with CMS payment and reimbursement methodology in the managed care environment
Knowledge of CMS risk adjustment/HCC model with coding and documentation guidelines
Ability to interpret clinical chart documentation, analyze and apply accurately to coding guidelines and reporting followed by the principle of MEAT
Must possess strong knowledge of medical chart review audit experience in HCC coding and CMS RADV audits
Must possess a high degree of accuracy, efficiency, and dependability
Must possess time management, research, strong analytical, organizational, and problem-solving skills
Utilize creative thinking, and prioritize assignment projects to ensure deadlines are met
Must have strong oral and written communication and presentation skill sets
Must be detail-oriented, able to work independently with minimal supervision with highly confidential information per HIPAA regulation
Proficiency in Microsoft Outlook, Excel, Excel, and Presentation PowerPoint
Preferred
AA degree or Bachelor's degree in a related field preferred
Active Certifications through AHIMA and/or AAPC: Certified Professional Coder (CPC); Certified Coding Specialist (CCS); Physician (CCS-P); Registered Health Information Technician (RHIT); and Certified Risk Adjustment Coder (CRC) preferred
Company
Provisions Group
Provisions Group is a staffing and recruiting company offering IT and healthcare staffing solutions.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Mark Freeman
Partner
Recent News
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2024-05-01
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