2 coding auditor jobs found

Specialty / Procedures: Primary Care coding and charge review (Preventive, Chronic, Acute Visits; E/M, Time-Based, Preventive Care) Specialty Program(s): Coding & Charge Review, Risk Code Validation (non-HCC), Front-End & Pre-Billing Review Engagement Type (FT / PT / Contract): Full-Time Work Arrangement (Remote / Travel / On-site): Remote Length of Assignment:  Ongoing / Long-Term Credentials & Requirements Required Credentials / Licensure: Certified Professional Coder (CPC) or equivalent AAPC credential (required) Additional Requirements or Notes: Minimum 2 years of professional coding experience in Primary Care, Family Medicine, or Internal Medicine Strong knowledge of CPT, HCPCS, ICD-10-CM, E/M coding Experience with risk-related diagnosis validation (non-HCC) Knowledge of payer rules, modifier usage, medical necessity, and clean-claim standards Ability to maintain...

General Summary: This role focuses on the Risk Adjustment process that supports the documentation of acuity diagnoses for the Managed Care (MC) patient population and required activities for submission of records to Medicare Advantage (MA) payers under established capitated contracts. It assists with medical record reviews for HCC diagnoses, correct usage of various coding guidelines (ICD-10-CM, CPT, HCPCS) and federal and MA payor regulations, as well as clinical validation of appropriate supporting documentation.   Supervisory Responsibilities: This position has no supervisory responsibilities.   General Requirements: All duties performed will be done accurately and in a timely manner.   1.        Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy. 2.        Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers. 3.        Must...