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Coding Compliance HCC Auditor (Remote Oregon State)

Company: Bend Memorial Clinic
Location: Myrtle Point
Posted on: June 8, 2021

Job Description:

Job Description

Essential Job functions:

  • Coding Compliance HCC Auditor - Chart Reviews
  • Reviews medical record for proper assignment of diagnoses according to AMA, AHA, ICD-10-CM Guidelines.
  • Ensure diagnosis reporting meets all AMA, ICD-10-CM, HCC, Risk Adjustment Reporting, and CMS Guidelines
  • Utilizes a risk-based audit approach and establishes preliminary scope of reviews, incorporates patterns and trending analysis based on performing review and alerting the Manager and/or Director of any areas of identified concern
  • Proficiently utilizes available software daily to accomplish both Core and Job Specific Duties and Responsibilities. (e.g. Payer Reports Excel, Word, Encoder Pro, various EHR's, Microsoft Outlook, various Payer reports, HCC tools both from Payers and internal created priority data bases)
  • Provides education to Physicians and other staff on appropriate documentation needs as it relates to appropriate HCC code capture.

  • Maintains high-level of specialty specific coding and auditing guidelines as it relates to HCC concepts.
  • Utilizes logs to identify and communicate patterns and trends found in Audit Reviews
  • Understands and implements the MEAT concept
  • Recognizes and reports problems, errors and discrepancies in medical records
  • Review of physician reports (compensation reports, UPIP, etc.) for areas of needed HCC education or potential coding enhancement.
  • Prepares written reports findings to present to Manager, Physicians or other parties
  • Assist Management with special HCC projects as assigned
  • Demonstrates the ability to manage multiple projects
  • Ability to work various payor HCC payor gap reports
  • Ability to work data to establish internal gap report and HCC Provider focused lists
  • Meets productivity standards and turnaround times.
  • Anticipates and performs necessary duties.
  • Coding Compliance Educational Efforts
  • Conducts audit reviews related to Coding Compliance initiatives and communicates/collaborates with Coding Compliance Management and other teams regarding audit outcomes and educational areas of opportunity
  • Research and provide courteous, accurate and timely response to inquiries from physicians relating to HCC Risk Adjustment projects and reports
  • Provide detailed comments/feedback on physician performance based on both prospective and retrospective chart review (email communication, meetings, presentation, etc.)
  • Meet with management and assist in creating individual provider education plans tailored to provider's specific needs based on review findings
  • Serve as resource for internal and external customers to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.

General Job functions:

The Coding Compliance HCC Auditor must exhibit an understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations and guidelines, along with HCC and other risk adjustment reporting measures. Additionally, must exhibit the ability to apply a statistical methodology and scope approach for coding/documentation review and risk analysis.

Must exhibit proficiency in the use of HCC and ICD-10 auditing concepts are required in order to conduct formal chart reviews. The Auditor is responsible for both internal (scheduled, focused & project driven) and external audits for the purposes of monitoring compliance to final resolution. Formal documented outcomes, tracking of trends, compiling of assessment reports and educational communication to Managers and/or Providers with audit findings are required. Coding Compliance HCC Auditor is also expected to keep abreast of HCC reporting, specialty specific coding, auditing and compliance advances.

Physical Job Requirements:

  • Ability to multi-task, organize & prioritize work within any given setting
  • Endurance to work long hours on projects
  • Ability to process a large amount and distinct types of data
  • Ability to work in confined and/or various workstations
  • Ability to work with diverse personalities

Education, Certification, Computer and Training Requirements:

  • Associate Degree minimum / Bachelor Degree preferred
  • Work related experience: 2 years minimum
  • Auditing experience: 1 year minimum preferred
  • Previous supervising experience: preferred
  • Proficient use of Microsoft Office Applications (Excel, Word, PowerPoint)
  • Medical Coding Certificate - Required
  • Coding Certification - CRC, CPC, CCS-P, CCA, RHIT or RHIA- Required
  • Auditing, Compliance and Billing or Practice Management Certifications - CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, etc. - Preferred
  • Clinical and/or Population Health experience (e.g. RN, LPN, CNS) taken into consideration in lieu of coding certification (must obtain certification within 1 year)

Travel

  • Travel using personal vehicle is required to various locations (more than 1 mile).
  • National travel may be required.

Benefits*

  • A friendly and fast-paced environment working with passionate people

  • Outstanding growth opportunities

  • Time Off

  • Medical, Dental and Vision Insurance

  • Short/Long Term Disability, HSA, and Life Insurance

  • 401K plan with company matching contribution

  • Cash Bonus Programs

  • Recognition and rewards programs to recognize successful teams

  • Other Perks & Discounts

  • Commuter and parking discount program to help you save (using pretax dollars)

  • Full Time Benefit Eligible Employees Only

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.

Keywords: Bend Memorial Clinic, Medford , Coding Compliance HCC Auditor (Remote Oregon State), Other , Myrtle Point, Oregon

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