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Consultis, a premier Technical Solutions Provider and Executive Search Firm with the single focus of pairing the right candidate with the right employment opportunity is currently searching for an Health Information Coding Auditor (onsite position) for a Direct Hire opportunity (FTE) with our client in San Antonio, TX. The Health Information Coding Auditor will perform concurrent, prospective, and retrospective chart reviews and data validation to improve RAF score goals and maximize Company’s revenue. This role is responsible for reviewing and validating electronic medical records to ensure the accuracy of Hierarchical Condition Category (HCC) coding. The position reports to the Director of Risk Adjustment/HCC Coding. Key Responsibilities:
* Conduct prospective and retrospective audits of outpatient medical chart notes to verify accurate coding per ICD-10 CM guidelines and ensure proper HCC code capture for CMS reimbursement.
* Review medical records to identify and assess accurate coding based on CMS-HCC categories, abstracting HCC data not captured or submitted during CMS sweep periods.
* Assist with concurrent chart reviews, performing physician queries to clarify coding and documentation in alignment with established policies and procedures.
* Maintain a tracking tool for managing assigned medical record review projects.
* Meet defined productivity and quality metrics in accordance with QA policy.
* Participate in Health Plan RACCR and CMS Risk Adjustment Data Validation (RADV) audits as needed.
* Collaborate with the management team to select "best medical records" to validate HCC codes.
* Assist the Director of HCC Coding with post-audit reports when necessary.
* Stay informed on state and federal regulations, as well as ICD-CM coding guidelines.
* Participate in coding and documentation webinars provided by Optum, AHIMA, AAPC, or similar organizations on a monthly basis.
* Ensure compliance with HIPAA and state/federal regulations.
* Perform additional tasks or projects as assigned by management. Qualifications and Experience:
* Minimum of 3 years of coding experience, including 1 year of HCC/risk adjustment coding in a managed care or healthcare plan setting.
* At least 1 year of auditing experience with extensive knowledge of Medicare HCC coding protocols.
* Previous experience in coding and auditing medical charts within the healthcare field.
* Ability to work in a fast-paced, high-quality production environment.
* Strong ability to follow instructions, meet deadlines, and work independently.
* Ability to identify HCC improvement opportunities and provide feedback to physicians on documentation, HCC compliance, and coding guidelines. Education and Certifications:
* High School diploma or equivalent; an Associate's or Bachelor’s degree in a related field is preferred.
* Active certifications through AHIMA and/or AAPC are preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), CCS-P, Registered Health Information Technician (RHIT), or Certified Risk Adjustment Coder (CRC). Skills:
* Advanced knowledge of ICD-10-CM, CPT, HCPCS coding, medical terminology, anatomy, physiology, and pharmacology.
* Familiarity with CMS payment and reimbursement methodologies in managed care environments.
* Expertise in interpreting clinical documentation and applying coding guidelines, particularly MEAT (Monitor, Evaluate, Assess, Treat) principles.
* Proficiency in medical chart review audits, HCC coding, and CMS RADV audits.
* Strong accuracy, efficiency, and dependability.
* Excellent time management, analytical, organizational, and problem-solving skills.
* Strong oral and written communication and presentation skills.
* Detail-oriented, with the ability to work independently with minimal supervision and manage confidential information in compliance with HIPAA.
* Proficiency in Microsoft Outlook, Excel, and PowerPoint.
Job Type: Full-time
Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday
Ability to Relocate:
* San Antonio, TX: Relocate before starting work (Preferred)
Work Location: In person
* Conduct prospective and retrospective audits of outpatient medical chart notes to verify accurate coding per ICD-10 CM guidelines and ensure proper HCC code capture for CMS reimbursement.
* Review medical records to identify and assess accurate coding based on CMS-HCC categories, abstracting HCC data not captured or submitted during CMS sweep periods.
* Assist with concurrent chart reviews, performing physician queries to clarify coding and documentation in alignment with established policies and procedures.
* Maintain a tracking tool for managing assigned medical record review projects.
* Meet defined productivity and quality metrics in accordance with QA policy.
* Participate in Health Plan RACCR and CMS Risk Adjustment Data Validation (RADV) audits as needed.
* Collaborate with the management team to select "best medical records" to validate HCC codes.
* Assist the Director of HCC Coding with post-audit reports when necessary.
* Stay informed on state and federal regulations, as well as ICD-CM coding guidelines.
* Participate in coding and documentation webinars provided by Optum, AHIMA, AAPC, or similar organizations on a monthly basis.
* Ensure compliance with HIPAA and state/federal regulations.
* Perform additional tasks or projects as assigned by management. Qualifications and Experience:
* Minimum of 3 years of coding experience, including 1 year of HCC/risk adjustment coding in a managed care or healthcare plan setting.
* At least 1 year of auditing experience with extensive knowledge of Medicare HCC coding protocols.
* Previous experience in coding and auditing medical charts within the healthcare field.
* Ability to work in a fast-paced, high-quality production environment.
* Strong ability to follow instructions, meet deadlines, and work independently.
* Ability to identify HCC improvement opportunities and provide feedback to physicians on documentation, HCC compliance, and coding guidelines. Education and Certifications:
* High School diploma or equivalent; an Associate's or Bachelor’s degree in a related field is preferred.
* Active certifications through AHIMA and/or AAPC are preferred: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), CCS-P, Registered Health Information Technician (RHIT), or Certified Risk Adjustment Coder (CRC). Skills:
* Advanced knowledge of ICD-10-CM, CPT, HCPCS coding, medical terminology, anatomy, physiology, and pharmacology.
* Familiarity with CMS payment and reimbursement methodologies in managed care environments.
* Expertise in interpreting clinical documentation and applying coding guidelines, particularly MEAT (Monitor, Evaluate, Assess, Treat) principles.
* Proficiency in medical chart review audits, HCC coding, and CMS RADV audits.
* Strong accuracy, efficiency, and dependability.
* Excellent time management, analytical, organizational, and problem-solving skills.
* Strong oral and written communication and presentation skills.
* Detail-oriented, with the ability to work independently with minimal supervision and manage confidential information in compliance with HIPAA.
* Proficiency in Microsoft Outlook, Excel, and PowerPoint.
Job Type: Full-time
Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Paid time off
* Vision insurance
Schedule:
* 8 hour shift
* Monday to Friday
Ability to Relocate:
* San Antonio, TX: Relocate before starting work (Preferred)
Work Location: In person
