HCC Coding Auditor

Role Overview

• Utilize risk adjustment coding/HCC and HEDIS expertise to perform quality reviews on internal/subcontracted HCC coders/OP CDI.
• Use audit tool to analyze quality results and track overall quality.
• Provide necessary feedback and research to HCC Coder/ OP CDI in response to coding and documentation questions.
• Ability to assess queries for compliance and appropriate composition based on the AHIMA Query Practice Brief.
• Prepare and deliver training on HCC documentation requirements, customized to the client audience (e.g., providers, HCC coders).
• Assess HCC coders/OP CDI chart reviews for missed documentation or query opportunities impacting RAF scores/HEDIS measures.
• Review charts to assure clinical documentation supports MEAT requirements and identify trends in documentation gaps.
• Provide education to HCC Coders/OP CDI as needed based on audit findings.
• Identify trends and perform training to improve HCC capture, HEDIS measure review, and quality.
• Work with Manager to identify performance needs of Coders/OP CDI and create training to increase performance levels.

Requirements

• RN required
• Coding credential of CCS or CRC preferred
• 2-5 years of experience in auditing HCCs (prospective & retrospective) or outpatient CDI
• Experience with Microsoft Office including 365, Word, Excel, PowerPoint
• Experience working with offshore teams, preferred
• 3 years of experience in auditing an ambulatory clinic setting, with knowledge of ICD-10-CM, HCC and CPT/HCPCS coding requirements, as well as OP CDI and HEDIS measures

Benefits

• UASI provides a supportive environment that encourages professional development and enables each employee to achieve their individual goals.
• We offer a competitive pay and excellent benefit package.