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$53,400.00–$85,600.00

Risk Adjustment Coding Auditor II

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Full-time Remote 7d ago

Location:

US

Company:

CareSource is a nonprofit health insurance provider focused on improving health outcomes for its members.

Summary:

This role involves validating ICD-10 codes and auditing documentation for accuracy. Applicants must have experience in diagnostic coding and auditing medical records, along with a high school diploma or GED.

Requirements:

Technology: Microsoft Word, Microsoft Outlook, Microsoft Excel

Hard Skills: ICD-10, medical coding, auditing medical records, researching CMS guidelines

Credentials: High School Diploma or GED

Experience: Minimum of three (3) years of diagnostic coding experience, A minimum of three (3) years of experience in auditing medical records, Risk Adjustment methodology experience

Job Description:

Job Summary:

The Risk Adjustment Coding Auditor II is responsible for performing over-reads of vendor ICD-10 coding, reviewing provider documentation supplied to them, and diagnostic codes assigned by vendor.

Essential Functions:

  • Meets assigned volume metrics
  • Validates the accurateness of ICD-10 codes assigned by the vendor
  • Tracks the trends and reports on the findings
  • Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products
  • Participates in quality coding initiatives as appropriate or assigned
  • Maintains knowledge of AHA Coding Clinic and ICD-10 Official Guidelines for Coding and Reporting
  • May be asked to perform over reads of provider coding/documentation
  • Meets deadlines and works independently on multiple projects
  • Perform any other job duties as requested

Education and Experience:

  • High School Diploma or GED is required
  • Minimum of three (3) years of diagnostic coding experience and a firm understanding of ICD-10 is required
  • A minimum of three (3) years of experience in auditing medical records is required
  • Risk Adjustment methodology experience required

Competencies, Knowledge and Skills:

  • Intermediate level with Microsoft Word, Microsoft Outlook, Microsoft Excel
  • Ability to work in a fast paced production environment while maintaining high quality
  • Knowledgeable and experienced with researching  CMS and other sites for Risk Adjustment guidance
  • Exceptional knowledge of medical coding and regulatory requirements
  • Knowledgeable of Medicaid, Medicare, Exchange
  • Knowledgeable of ICD-10
  • Ability to make independent decisions on ICD 10 code assignments
  • Excellent verbal and written communication skills
  • Ability to effectively interface with teammates, vendors and management
  • Ability to work with others and work independently
  • Possesses critical thinking/listening skills
  • Strong interpersonal skills and high level or professionalism
  • Detail oriented
  • Facets training/knowledge is preferred

Licensure and Certification:

  • AAPC or AHIMA coding certification is required

Working Conditions:

  • General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

$53,400.00 - $85,600.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Hourly

Organization Level Competencies

  • Create an Inclusive Environment

  • Cultivate Partnerships

  • Develop Self and Others

  • Drive Execution

  • Influence Others

  • Pursue Personal Excellence

  • Understand the Business