HCC Coding Quality Specialist

JOB SUMMARY:

Overview

We are looking to expand our HCC Auditing Team!

HCC Auditing Team Members will be responsible for reviewing the accuracy of our HCC coded records, specifically those that map to HCCs, RxHCCs, and ESRD. Auditors will support their findings utilizing Medicare guidelines, ICD-10-CM guidelines, Coding Clinic, as well as client specific requirements.

Details

Full Time (40 hours/week)
Flexible hours following initial 6-8 week training period: expected working hours are between 6am and 9pm ET Monday – Friday.
Location: Remote/Work from home
Required: 3 years of retrospective HCC coding experience with 2 years auditing experience.
Required: A valid AAPC or AHIMA coding credential. (Apprenticeship designations are not accepted.)
Acceptable credentials would be CPC, CRC, RHIT, CCS, or CCS-P.

Benefits for Full Time Team Members:

PTO
401K
Health Insurance
Disability Insurance
Vision Insurance
Dental Insurance
Equipment provided
Encoder software with access to AHA Coding Clinic

Responsibilities

• 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.
• Support your findings in a way the coder can easily identify and learn from the error.
• Have strong and professional communication skills.
• Be a resource for HCC coding team members by having a deep understanding of the project and coding guidelines.
• Follow Risk Adjustment Data Abstraction Rules.
• Will be required to maintain a quality score of 97% or higher.
• Will be required to maintain an ongoing productivity level based on project requirements.
• 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.
• Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program.
• Comply with all internal policies and procedures.
• Regular, predictable, and punctual attendance is required.

Qualifications

• All auditors MUST be certified through either the AAPC or AHIMA. (Apprenticeship designations are not accepted.)
  • Acceptable credentials would be CPC, CRC, RHIT, CCS, or CCS-P.

• Must have at least a 3 years of retrospective HCC coding experience with 2 years of auditing experience.
• Must have working knowledge and experience with systems such as EMRs, Billing systems, abstraction platforms, etc.
• Must have a phone, reliable internet connection.
• Team Member must be able to work from home and be independent in their coding skills.
• Must be proficient in Microsoft programs like Excel and Outlook. Examples include:
  • Excel: you should be able to open and add to a spreadsheet, perform basic formulas like adding or multiplying.
  • Outlook: you should be able to manage emails and schedule and attend meetings.
• Ability to communicate effectively and professionally both verbally and written.
• Ability to coordinate, analyze, observe, make decisions, and meet deadlines. 
• May be required to perform other duties as assigned by Leadership Team Member.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.
Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.