Coding Quality Auditor - Revenue Cycle

Job Title

HCC Coding Quality Auditor

Job Description

Under the supervision of the Quality Integrity Program Manager, 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. Serves as a coding expert, working with the Quality Integrity Program manager and clinical documentation review team to ensure compliance with Official Coding Guidelines for Coding and Reporting, coding conventions and regulatory oversight agencies. This includes the identification and researching of provider diagnostic coding concerns, documentation compliance standards, and performing education related to provider coding errors. The incumbent supports the mission and core values of PacMed through responsible and effective work performance.

Providence caregivers are not simply valued they're invaluable. Join our team at Pacmed Clinics DBA Pacific Medical Centers and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications

• Upon hire: Coding Certification (Facility Managed)
• 3 years Experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU's.
• Experienced in reviewing patient account information, insurance explanation of benefits, computer screens, and financial records.

Preferred Qualifications

• Associate's Degree.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Providence Health & Services