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
Organization Level Competencies
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Leveraging Feedback
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Customer Orientation
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Valuing Differences
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Managing Work
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Earning Trust
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Quality Orientation
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Adaptability
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Influencing
-
Collaborating
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.
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