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AUDITOR, CODING

Company: Coast Healthcare
Location: Cypress
Posted on: March 15, 2020

Job Description:

Position Summary: The Clinical Coding Specialist is responsible for handling risk adjustment related activities to ensure that CMS coding and documentation guidelines are met and members risk scores are accurately reflected. This position will assist in developing strategies to improve risk score performance through collaborations with health plans and providers. The responsibilities include performing chart reviews to identify coding opportunities, participate in training seminars, physician education, perform internal chart audits to ensure preparedness for potential RADV audits, and other projects as assigned. Responsibilities: Perform ongoing chart reviews of targeted physician offices in a timely manner for HCC data extraction to meet CMS sweep deadlines Perform ongoing chart audits of targeted physician offices to ensure HCC data is validated in preparation for health plan internal audits and/or CMS RADV audits. Responsible for the data collection of medical records as requested by the plans for chart audit/review purposes Responsible for preparing chart audit findings and communicating this back to physicians in timely manner Responsible for presenting chart audit findings as well as physician performance trends to management Develop physician group training utilizing data and findings from chart reviews to help ensure proper documentation elements are in place Provide risk adjustment in-services to physician offices as needed Responsible for the development of content for monthly fax blast, quarterly provider newsletter, and website Assist in developing strategic initiatives related to HCC score improvement for physician and IPA Responsible for the development of risk adjustment tools as needed and/or as requested by physician offices Annual update of PCP and Specialist superbills Perform audits of HCC patient data as reported by health plans for purposes of reconciliation of payment Participate in tele-conferences and off site conferences as needed to be informed of current CMS requirements Provide training to appropriate internal staff related to HCC documentation and coding Perform other assigned duties / special projects on an as-needed basis. Foster positive interaction and relationships with all internal departments as well as cultivating positive working relationships with external contacts. Qualifications: Prefer 1 year of healthcare coding experience Current Certified Professional Coder license or higher equivalent Strong verbal and written communication skills Strong knowledge of CMS Risk Adjustment requirements Strong team player Strong computer skills Ability to travel locally. Requires comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and privacy of protected patient information.

Qualifications:
EducationRequired: AA Degree
Preferred: Bachelors degreeExperienceRequired: 5 years coding experienceCertificationsRequired: RHIA, RHIT, CCS, COC, CPC or COC Job: Medical Coding Primary Location: Cypress, California Facility: Coast Healthcare Job Type: Full-time Shift Type: Days

Keywords: Coast Healthcare, Cypress , AUDITOR, CODING, Accounting, Auditing , Cypress, California

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