QA Auditor

Quality Assurance Coder/Auditor

We are currently seeking a Quality Assurance Coder/Auditor for a contract role with one of our clients. Please apply if you are interested and available for it.

Responsibilities:

• Demonstrate comprehensive understanding of HCC Coding rules, regulations, methodology and the role of hierarchies.
• Reviewing medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements.
• Determine valid encounters, including face-to-face, legibility and valid signature, according to Medicare Managed Care requirements.
• Perform QA audits on vendor and provider group supplemental data submissions. Provide corrective action recommendations when accuracy scores fall below 95%.
• Track QA audits and send out monthly updates to Vendor and management team. Updates include report findings and recommendations regarding closing healthcare gaps, medical record documentation, coding, and additional educational training to management.
• Develop effective provider/coder education program in support of risk mitigation analysis. This includes writing education tips for BCBSAZ publications and preparing materials for presentation during Zoom calls.
• Correct encounter rejections within vendor platform.
• Maintain current knowledge of the Medicare Managed Care Manual, Chapter 7 - Risk Adjustment and Medicare outpatient billing systems/processes.
• Maintain coding certification and stay current with the numerous changes in risk adjustment methodologies.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

Qualifications:

• Excellent understanding of the CMS crosswalk of ICD diagnosis codes to Hierarchical Condition Category (HCC) codes and impact of diagnosis coding on risk adjustment payment models.
• Sufficient knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses according to CMS and ICD-10 coding guidelines.
• General knowledge of the provisions contained in Chapter 7 – Risk Adjustment, Medicare Managed Care Manual.
• Strong writing skills.
• Computer proficiency in MS Word.
• Ability to prepare and present PowerPoint slides.
• Ability to create Excel spreadsheets and perform basic functions in Excel.
• Ability to learn organizational systems and software applications.
• Basic knowledge and understanding of primary care provider office practices, electronic and manual medical record systems, and billing processes.
• Ability to develop training materials and conduct educational training to close healthcare gaps, improve medical record documentation, and ensure complete and accurate coding.
• Ability to identify and effectively communicate medical record documentation and/or correct coding deficiencies to providers and their staff.