Job Title: Quality Assurance Coder/Auditor Location: Phoenix, AZ (Hybrid, Required to Travel into the office 1 x per week) Duration: 6 Months (possibility of extension or conversion) Department: Medicare/ Medicaid Purpose The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. On a regular basis, the Coder/Auditor will educate primary care providers and their staff on their historical diagnoses/coding error trends, accurate completion of medical record documentation, and at‑risk code identification and risk mitigation. This includes the review, analysis, and recommended coding based on medical and clinical diagnoses, procedures, injuries, or illnesses contained in medical records and supporting documentation. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at‑risk single occurrences of HCCs and OIG targets. Deletions will be submitted for unsupported/invalid diagnoses. This analysis combined with QA findings and EDPS claims errors will drive the content and audience for provider education. The Quality Assurance Coder/Auditor will perform medical record reviews and abstract codes to the highest specificity effectively from medical records based on the documentation provided. The coder/auditor is responsible for ensuring diagnosis codes selected come from a face‑to‑face visit with a valid risk‑adjustable provider. The coder/auditor will perform QA for vendors and other submitters of supplemental HCC data and provide educational feedback relevant to the same. Responsibilities Comprehensive understanding of HCC coding rules, regulations and methodology Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements Determine valid encounters, including face‑to‑face, legibility and valid signature, according to Medicare Managed Care requirements Track QA audits and send out monthly updates to vendor and management team. Updates include report findings and recommendations regarding closing healthcare gaps, medical record documentation, coding, and additional educational training to management. The goal is >95% accuracy in QA audits Accurately and efficiently conduct medical record review/abstraction services Develop effective provider/coder education program in support of risk mitigation analysis Travel to physician offices, conduct on‑site educational training on how to close identified health‑care gaps, accurately document in medical record, and submit claims with correct coding. Track educational training sessions by date, provider, topic, number of attendees, etc. Other duties as assigned Maintain current knowledge of the Medicare Managed Care Manual, Chapter 7 – Risk Adjustment and Medicare outpatient billing systems/processes Maintain coding certification and stay current with the numerous changes in risk adjustment methodologies The position requires a full‑time work schedule. Full‑time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. Required Experience 5 years of professional medical coding experience, with at least 3 years of HCC coding experience. Advanced knowledge of coding guidelines and coding in healthcare products. Required Certifications Certified Coding Specialist – Physician Based (CCS‑P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coder (COC) credential Education requirement High school diploma or GED in general field of study Ideal years of experience 5+ years #J-18808-Ljbffr
Quality Assurance Coder/Auditor • Phoenix, AZ, United States
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