Coding Quality Auditor - Revenue Capture

Overview Under the supervision of the Coding Manager, Revenue Capture, the HCC Coding Quality Auditor is responsible for detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding. The incumbent reviews and abstracts HCC codes to ensure they are coded accurately, to the highest specificity, queries providers to clinically validate or clarify diagnosis criteria, and reviews for compliant documentation resulting in compliant reporting/billing and RVU capture. Responsibilities Conduct detailed chart reviews of clinical documentation and coding related to Risk Adjustment and HCC coding. Abstract HCC codes with high specificity and accuracy. Query providers to clinically validate or clarify diagnosis criteria when needed. Evaluate documentation for compliance to ensure accurate reporting and RVU capture. Required Qualifications Within 1 year of hire: Certified Professional Coder (CPC) or within 1 year of hire: Certified Coding Specialist (CCS) 2 years of experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU’s Experience reviewing patient account information, insurance explanation of benefits, computer screens, and financial records Preferred Qualifications Bachelor\'s Degree or equivalent education/experience Within 1 year of hire: Certified Risk Adjustment Coder (CRC) Within 1 year of hire: Certified Professional Medical Auditor (CPMA) or within 1 year of hire: Certified Healthcare Compliance Auditor (CHCA) Experience in HCC coding Providence is an Equal Opportunity Employer. #J-18808-Ljbffr Providence Swedish Medical Center