HCC Auditor

Job Description

Job Description

Description:

At e4health, we Empower Better Health. The e4health Team is on a relentless mission to care for those teams who care for others. We bring our passion, ingenuity, and expertise to every engagement. In joining our Team, we want your help to provide our customers with powerful solutions in the pursuit of quality, integrity, clinical and financial value across healthcare.

Our People make the difference. Serving more than 400 hospitals and health systems nationwide for nearly two decades, e4health provides solutions to tackle the toughest problems in healthcare with unmatched technology, mid-revenue cycle, and operational expertise. e4health solutions streamline clinical, financial, and health information data and workflows, optimize coding, quality, and clinical documentation integrity processes, and address health IT operational challenges to deliver material results for healthcare organizations across the country. Learn more about us at

JOB SUMMARY:

The Medical Coding Integrity Specialist, HCC is responsible for completing quality assurance reviews on internal or external coders/providers/accounts following the official ICD-10-CM and appropriate Risk Adjustment guidelines. This role will be responsible for reviewing a patient’s medical record and validating the assignment of HCC codes (and possibly complete code capture) for completeness and accuracy. The Medical Coding Integrity Specialist also plays a key role in reporting quality results, tracking and trending of educational opportunities, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The Medical Coding Integrity Specialist is expected to maintain consistent auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards.

CORE COMPETENCIES:

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability
• Meeting Standards

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

Sitting, talking, hearing and near vision are required over 90% of the time, while walking is required frequently throughout the day. Standing is required over 10% of the time. Feeling is required 90% of the time and reaching is required about 50% of the time. Bending, twisting and climbing are required, as in far vision, but only for 10% or less of the time. Low levels of lifting (10 pounds of less) is required about 25% of the time, while medium levels (20 to 40 pounds) of lifting and carrying are required less than 5% of the time. Ability to travel to field sites may be required up to 15% of the time.

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

Over 90% of the time is spent indoors, with protection from weather conditions. Exposure to noise levels that may be distracting or uncomfortable is present in only unusual situations.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions
• Advanced knowledge and understanding of HCC/risk adjustment, coding and documentation requirements
• Demonstrate ability to perform accurate and complete chart audits for HCC/risk adjustment
• Demonstrated ability to identify and communicate trends in provider coding and documentation
• Excellent written, verbal, communication, and attention to detail skills
• Reviews submitted medical records to identify diagnoses, ensuring that HCC coding guidelines are followed
• Ensures all diagnoses are accurate and complete from the medical record in accordance with ICD-10 CM Guidelines for Coding and Reporting
• Confirms the correct code to the highest level of specificity as documented in the medical records
• Works effectively and efficiently within a team environment
• Complies with policies and procedures for confidentiality of all patient records and security of systems

REQUIRED QUALIFICATIONS:

• Candidate must possess an approved AHIMA or AAPC coding credential. CRC (Certified Risk Adjustment Coder) preferred
• Minimum 2 years’ coding with 2 years specific HCC experience required; specialty experience may be preferred as per specific client needs
• Minimum 2 years of auditing experience preferred
• Recommend at least 2 years of remote experience

KEY SUCCESS ATTRIBUTES:

• Demonstrates strong communication and collaboration skills
• Has strong organizational, analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment
• Demonstrate excellent interpersonal as well as well-developed written and verbal communication skills, including deep listening and attention to detail
• Possess strong time management skills
• Commitment and adherence to company Core Values