Risk Adjustment (RA)/HCC Coder/Auditor

Job Description

Job Description

Description:

About e4health

At e4health, our vision is to Empower Better Health for our clients, our team, and the communities we serve. We live by five core values that guide everything we do:

• Embrace Change, Fun, and Learning: We maintain an unrelenting focus on quality, client success, and team member growth.
• Our PEOPLE Make the Difference: We build trusted relationships and celebrate wins every day.
• WE GROW: We believe in win/win outcomes—when our customers win, we win.
• GSD (Get Stuff Done): We say no to politics, drama, and egos, and yes to informed, agile decisions.
• Respectfully Listen, Challenge, & Support Each Other: We listen intently, challenge respectfully, and support fully.

POSITION TITLE:

HCC Auditor

ROLE TYPE:

Full Time / Part Time

EMPLOYMENT TYPE:

Non-Exempt

JOB SUMMARY:

The HCC Auditor is responsible for completing quality assurance reviews on internal or external coders/providers/accounts following the official ICD-10-CM and appropriate Risk Adjustment guidelines. This role will be responsible for reviewing a patient’s medical record and validating the assignment of HCC codes (and possibly complete code capture) for completeness and accuracy. The HCC Auditor also plays a key role in reporting quality results, tracking and trending of educational opportunities, responding to client subject matter needs, and providing educational support and training to coders and/or providers. The HCC Auditor is expected to maintain a consistent auditing accuracy rate of 95% or better while also meeting agreed upon productivity standards. 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Completes all regularly scheduled quality assurance reviews for clients
• Knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions
• Advanced knowledge and understanding of HCC/risk adjustment, coding and documentation requirements
• Demonstrate ability to perform accurate and complete chart audits for HCC/risk adjustment
• Demonstrated ability to identify and communicate trends in provider coding and documentation
• Excellent written, verbal, communication, and attention to detail skills
• Ensures all diagnoses are accurate and complete from the medical record in accordance with ICD-10 CM Guidelines for Coding and Reporting
• Confirms the correct code to the highest level of specificity as documented in the medical records
• Works effectively and efficiently within a team environment
• Complies with policies and procedures for confidentiality of all patient records and security of systems
• Maintains required productivity and quality requirements
• Maintains coding credential requirements

REQUIRED QUALIFICATIONS:

• Must possess an approved AHIMA/AAPC credential
• Minimum 3 years coding experience (inpatient, outpatient or physician office)
• HCC/RA experience preferred

KEY SUCCESS ATTRIBUTES:

• Integrity, passion, and ethics are required  
• Demonstrates strong collaboration skills  
• Has strong analytic and problem-solving abilities and techniques  
• Exhibit consistent initiative with strong drive for results and success  
• Demonstrate commitment to a team environment
• Well-developed written, verbal, and presentation communication skills including deep listening and attention to detail
• Ability to self-motivate and self-direct
• Possess strong time management and organizational skills
• Commitment and adherence to company Core Values 

CORE COMPETENCIES:

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability  
• Meeting Standards 

BENEFITS:

We offer an excellent salary, full benefits package including 401(k) with company match, medical, dental, vision, life, short/long term disability insurance, and PTO policy.

PHYSICAL DEMANDS OF THE ESSENTIAL FUNCTIONS:

• This role requires prolonged periods of desk working on a computer
• Talking, hearing, and near vision are required to perform computer-based tasks and virtual communication
• Sensory perception (visual, auditory, and tactile) is essential for computer and phone use

WORKING CONDITIONS WHILE PERFORMING ESSENTIAL FUNCTIONS:

This is a remote role; the majority of the work is performed in a home office environment, except when traveling to field sites.

e4health is an equal opportunity employer and will consider all applications without regard to race, color, religion, national origin, ancestry, marital status, veteran status, age, disability, pregnancy, genetic information, gender, sexual orientation, gender identity or any other legally protected category.

Applicants for U.S. based positions with e4health must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Visa sponsorship is not available for this position.

REQUIRED QUALIFICATIONS:

• Candidate must possess an approved AHIMA or AAPC coding credential - CRC (Certified Risk Adjustment Coder) preferred
• Minimum 4 years’ coding with 2 years specific HCC experience required; specialty experience may be preferred as per specific client needs
• 30 hour commitment preferred per week
• Recommend at least 2 years of remote experience

KEY SUCCESS ATTRIBUTES:

• Demonstrates strong communication and collaboration skills
• Has strong organizational, analytic and problem-solving abilities and techniques
• Exhibit consistent initiative with strong drive for results and success
• Demonstrate commitment to a team environment
• Demonstrate excellent interpersonal as well as well-developed written and verbal communication skills, including deep listening and attention to detail
• Possess strong time management skills
• Commitment and adherence to company Core Values

CORE COMPETENCIES:

• High level of integrity & ethical judgement
• Communication
• Consistency and Reliability
• Meeting Standards