HealthTexas Primary Care Doctors
HCC Auditor **Salary 60-80k DOE*** Hybrid 2 -3 days per week
HealthTexas Primary Care Doctors, San Antonio, Texas, United States, 78208
HCC Auditor - Salary 60-80k DOE - Hybrid 2-3 days per week
Overview
Under the direction of the management team, the HCC Auditor is responsible for performing concurrent, prospective and retrospective chart reviews and data validation to improve the department’s RAF score goals and maximize HTMG’s revenue. This position reviews and validates electronic medical charts to ensure the accuracy of HCC codes captured in encounter data submissions and supports coding and documentation clarification through physician queries during the prospective chart review process. The incumbent assists in identifying coding opportunities and areas for provider educational outreach, and supports management in selecting the best medical records for Health Plan chart review and CMS RADV audits. This position reports to the Director of Risk Adjustment/HCC Coding. The role contributes to HealthTexas mission, vision, and values.
Responsibilities
Conduct prospective and retrospective chart review audits on outpatient notes to ensure documentation supports correct ICD-10-CM coding and HCC submission to CMS for reimbursement.
Review medical record information to identify accurate coding based on CMS HCC categories and abstract HCC data from provider notes as needed.
Support concurrent chart reviews and perform physician queries for coding and documentation clarification per policy.
Maintain tracking and management tools for assigned medical record review projects.
Meet and maintain productivity and quality metrics as defined by QA policy.
Participate in Health Plan RACCR and CMS RADV audits as needed.
Assist management in selecting best medical records to validate and support HCC codes.
Assist the Director of HCC Coding with post-chart review audit findings reports when necessary.
Stay current with state, federal rules and ICD-CM coding guidelines; attend relevant webinars on coding and documentation.
Follow HIPAA protocol and comply with state and federal regulations.
Other duties or projects as assigned by management.
Experience
Must have a minimum of 3 years of coding experience, with at least 1 year in HCC/risk adjustment coding in a managed care environment.
Up to 1+ year of auditing experience and extensive knowledge of Medicare HCC coding protocol required.
Prior experience in healthcare coding and auditing of medical charts is required.
Ability to work in a fast-paced production environment with high quality, follow instructions, meet deadlines, and work independently.
Ability to identify HCC improvement opportunities and provide feedback to physicians on documentation, HCC compliance, and coding guidelines.
Education
High School diploma or equivalent; AA or Bachelor's degree in a related field preferred.
Active certifications through AHIMA and/or AAPC (e.g., CPC, CCS, CCS-P, RHIT, CRC) preferred.
Knowledge, Skills & Abilities
Advanced knowledge of ICD-10-CM, CPT, HCPCS coding, medical terminology, anatomy and physiology, and pharmacology.
Knowledge of CMS payment and reimbursement methodology in a managed care environment.
Understanding of CMS Risk Adjustment/HCC model and coding/documentation guidelines.
Ability to interpret clinical chart documentation and apply coding guidelines accurately (MEAT principles).
Strong accuracy, efficiency, dependability, time management, research, analytical, organizational, and problem-solving skills.
Strong written and verbal communication and presentation skills; ability to work independently with confidential information per HIPAA.
Proficiency with Microsoft Outlook, Excel, and PowerPoint.
Hours, Travel and Working Conditions
Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m., with additional time as needed to complete projects.
Travel to medical offices may be necessary to provide education and support.
Office-based role with standard office equipment; some filing and occasional lifting of files may be required.
Employment type
Full-time
Job function
Accounting/Auditing and Finance
Industries
Medical Practices
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Responsibilities
Conduct prospective and retrospective chart review audits on outpatient notes to ensure documentation supports correct ICD-10-CM coding and HCC submission to CMS for reimbursement.
Review medical record information to identify accurate coding based on CMS HCC categories and abstract HCC data from provider notes as needed.
Support concurrent chart reviews and perform physician queries for coding and documentation clarification per policy.
Maintain tracking and management tools for assigned medical record review projects.
Meet and maintain productivity and quality metrics as defined by QA policy.
Participate in Health Plan RACCR and CMS RADV audits as needed.
Assist management in selecting best medical records to validate and support HCC codes.
Assist the Director of HCC Coding with post-chart review audit findings reports when necessary.
Stay current with state, federal rules and ICD-CM coding guidelines; attend relevant webinars on coding and documentation.
Follow HIPAA protocol and comply with state and federal regulations.
Other duties or projects as assigned by management.
Experience
Must have a minimum of 3 years of coding experience, with at least 1 year in HCC/risk adjustment coding in a managed care environment.
Up to 1+ year of auditing experience and extensive knowledge of Medicare HCC coding protocol required.
Prior experience in healthcare coding and auditing of medical charts is required.
Ability to work in a fast-paced production environment with high quality, follow instructions, meet deadlines, and work independently.
Ability to identify HCC improvement opportunities and provide feedback to physicians on documentation, HCC compliance, and coding guidelines.
Education
High School diploma or equivalent; AA or Bachelor's degree in a related field preferred.
Active certifications through AHIMA and/or AAPC (e.g., CPC, CCS, CCS-P, RHIT, CRC) preferred.
Knowledge, Skills & Abilities
Advanced knowledge of ICD-10-CM, CPT, HCPCS coding, medical terminology, anatomy and physiology, and pharmacology.
Knowledge of CMS payment and reimbursement methodology in a managed care environment.
Understanding of CMS Risk Adjustment/HCC model and coding/documentation guidelines.
Ability to interpret clinical chart documentation and apply coding guidelines accurately (MEAT principles).
Strong accuracy, efficiency, dependability, time management, research, analytical, organizational, and problem-solving skills.
Strong written and verbal communication and presentation skills; ability to work independently with confidential information per HIPAA.
Proficiency with Microsoft Outlook, Excel, and PowerPoint.
Hours, Travel and Working Conditions
Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m., with additional time as needed to complete projects.
Travel to medical offices may be necessary to provide education and support.
Office-based role with standard office equipment; some filing and occasional lifting of files may be required.
Employment type
Full-time
Job function
Accounting/Auditing and Finance
Industries
Medical Practices
Referrals increase your chances of interviewing at HealthTexas Primary Care Doctors. Get notified about new Auditor jobs in San Antonio, TX.
#J-18808-Ljbffr