[Hiring] Coding Quality Auditor @Providence

Role Description

Under the supervision of the Coding Manager, Revenue Capture, the HCC Coding Quality Auditor is responsible for detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding. The incumbent reviews and abstracts HCC codes to ensure they are coded accurately, to the highest specificity, queries providers to clinically validate or clarify diagnosis criteria, and reviews for compliant documentation resulting in compliant reporting/billing and RVU capture. Serves as a coding expert, working with the Quality Integrity Program manager and clinical documentation review team to ensure compliance with Official Coding Guidelines for Coding and Reporting, coding conventions and regulatory oversight agencies.

Qualifications

• 2 years of experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU’s.
• Experienced in reviewing patient account information, insurance explanation of benefits, computer screens, and financial records.
• Within 1 year of hire: Certified Professional Coder (CPC) Or Certified Coding Specialist (CCS)

Requirements

• Bachelor's Degree or equivalent educ/experience (preferred).
• Within 1 year of hire: Certified Risk Adjustment Coder (CRC)
• Within 1 year of hire: Certified Professional Medical Auditor (CPMA) Or Certified Healthcare Compliance Auditor (CHCA)
• Experience in HCC coding.

Benefits

• Best-in-class benefits designed to support you and your family in staying well, growing professionally, and achieving financial security.
• Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance and disability insurance.
• Time off benefits (paid parental leave, vacations, holidays, health issues).
• Voluntary benefits and well-being resources.