Role Description
HCC Coding Quality Specialist Team Members will be responsible for reviewing the accuracy of our HCC coded records, specifically those that map to HCCs and RxHCCs. Auditors will support their findings utilizing Medicare guidelines, ICD-10-CM guidelines as well as client specific requirements. Global experience is beneficial.
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Ensure that the codes captured are supported by the documentation within the record and are properly coded following Medicare guidelines, ICD-10-CM guidelines as well as client specific guidelines for the project.
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Support your findings in a way the coder can easily identify and learn from the error.
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Have strong and professional communication skills.
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Be a resource for HCC coding team members by having a deep understanding of the project and coding guidelines.
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Follow Risk Adjustment Data Abstraction Rules.
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Assist with the creation of PowerPoints presentations for training purposes.
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Maintain a quality score of 95% or higher.
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Maintain an ongoing productivity level based on project requirements.
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Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information.
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Align conduct with AHIMA's Standards of Ethical Coding and the Companyโs Code of Ethics and Business Conduct and support the Companyโs Ethics and Compliance Program.
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Comply with all internal policies and procedures.
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Regular, predictable, and punctual attendance is required.
Qualifications
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All auditors MUST be certified through either the AAPC or AHIMA. (Apprenticeship designations are not accepted.) Acceptable credentials would be CPC, CRC, CCS, or CCS-P.
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Must have at least 3 years of HCC coding experience with 2 years of auditing experience. Global experience preferred.
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Must have working knowledge and experience with systems such as EMRs, Billing systems, abstraction platforms, etc.
Requirements
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Remote Work from home (within the U.S. ONLY). You need a HIPAA compliant home office, high-speed secure internet connection, equipment will be provided.
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Flexible scheduling after training, quality and productivity goals are met.
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Full-time (40 hours/week) you MUST be available for full time hours.
Benefits
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Accrued PTO, Paid Holidays.
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Medical/Dental/Vision Insurance.
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401k, CEUs and more!
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Competitive hourly salary commensurate with experience.