Coding
Compliance HCC Auditor
Berkeley Heights, NJ
At Summit Health Management (SHM), our goal is to positively impact the
quality and availability of health care across the country while ensuring the
continued vitality of patient-centric, physician-owned and governed medical
groups. Established in 2014 by the physician owners of Summit Medical Group
(SMG), one of the largest and most highly regarded independent multispecialty
medical groups in the nation, SHM drives performance enhancements for its
partners by providing expertise in organizational structure and governance,
operations, revenue cycle management, physician management, population health
management and other administrative and clinical functions.
As an integral
member of our Coding Compliance Department, and reporting to the Supervisor of
National HCC Services, you will oversee both internal (scheduled, focused and
project driven) and external audits for the purpose of monitoring compliance to
final resolution. In addition, you will review medical records for proper
assignment of diagnoses, as well as ensure diagnosis reporting meets all AMA,
ICD-10-CM, HCC, Risk Adjustment Reporting, and CMS Guidelines per in-house
process.
Responsibilities
include:
·
Utilizing a risk-based audit approach and establishing preliminary scope
of reviews, as well as incorporating patterns and trending analysis based on
performing reviews
·
Providing education to physicians and staff on appropriate documentation
needs
·
Maintaining a high level of specialty specific coding and auditing
guidelines
·
Utilizing logs to identify and communicate patterns and trends found in
audit reviews
·
Conducting audit reviews related to Coding Compliance initiatives and
communicating audit outcomes to management, along with educational areas of
opportunity
·
Researching and providing timely response to inquiries from physicians
relating to HCC Risk Adjustment projects and reports
·
Providing detailed comments/feedback on physician performance based on
retrospective chart reviews
·
Working with management to create individual provider education plans
·
Assisting management with special HCC projects
·
Handling other related functions as necessary
To qualify, you
must have an Associates’ Degree (Bachelor’s preferred), Medical Coding
Certificate, and 2 years of related work experience that includes at least 1
year of auditing experience, and preferably, prior supervisory experience. An
understanding of coding concepts, AMA, CMS/OIG/Federal/State regulations and
guidelines, along with other risk adjustment reporting measures will be
expected, as will proficiency in the use of HCC and ICD-10 auditing concepts. Coding
Certifications (CRC, CPC, CCS-P, CCA, RHIT or RHIA), and the ability to meet
productivity standards and turnaround times are a must. Excellent analytical,
problem-solving, oral/written communication, and PC (Excel, Word, PowerPoint)
skills essential. Any auditing, compliance, billing or practice management
certifications (CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, etc.) preferred.
We offer a competitive salary, comprehensive benefits package,
and a dynamic working
environment. For immediate consideration apply online at:
https://recruiting.adp.com/srccar/public/RTI.home?c=1152451&d=Summit_Health_Management&r=5000405996006&_fromPublish=true#/
Summit Health Management
https://jobs.summithealthmanagement.com/
We are a smoke and drug-free environment. EOE M/F/D/V