HCC Coding Quality Specialist

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

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.

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.

This is a remote position.

Location: Remote within US only

The ideal candidate will have at least 2 years of recent HCC Auditing experience in addition to 3 years of recent HCC/RA coding experience. You will be auditing the global team of Risk Adjustment coders.

All HCC/Risk Adjustment 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 AND have at least 3 years of HCC coding experience with 2 years of auditing experience. Global experience preferred.

Job Summary:

• 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.

• Assist with the creation of PowerPoints presentations for training purposes.

• Will be required to maintain a quality score of 95% 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, CCS, or CCS-P.

• Must have at least 3 years of HCC coding experience with 2 years of auditing experience. Global experience preferred.

• Must have working knowledge and experience with systems such as EMRs, Billing systems, abstraction platforms, etc.

What we offer:

• 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.

• Flexible scheduling after training, quality and productivity goals are met.

• Full-time (40 hours/week) you MUST be available for full-time hours.

• Benefits: Accrued PTO, Paid Holidays, Medical/Dental/Vision Insurance, 401k, CEUs and more!

• Competitive hourly salary commensurate with experience.

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.