Medical Quality Coder/Auditor Job in Vista, California

• Responsible for system wide requirements for accuracy in documentation to include ICD-10 and CPT codes, ensuring Quality Measures and Preventive services are completed for patients required by Managed Care, CMS, and Medicare Advantage guidelines
• Collaborate with IT and other departments as needed to ensure appropriate ICD-10 and CPT codes are updated annually in Electronic Medical Records (EMR) system
• Identify opportunities for improvement and apply appropriate process improvement methodologies
• Review patient medical records for HEDIS measures determined by the organization
• Accurately audit and review diagnoses codes to ensure highest level of specificity
• Accurately audit and review CPT procedures for appropriate services
• Review and update encounter documents on a continuous basis, ensuring completeness and accuracy with identification of problem trends affecting HCC, communicate correct coding to Clinicians
• Assist in the development of training materials with Clinical Quality Manager and staff
• Assist Clinical Quality Manager and staff in writing/establishing operating procedures to meet coding regulations/compliance and follow-up enhancement

Minimum

• High school graduate or equivalent
• Coding certification, preferably HCC Coder (Certification from AHIMA and/or AAPC)
• Minimum three years' medical coding experience ; Minimum two years' medical auditing experience
• Coding compliance program implementation experience
• Knowledge of Quality metrics and HEDIS
• Proficient ion Microsoft suite of products:  Excel, Outlook, Word, PowerPoint

Preferred

• Two years' experience in an FQHC environment
• Experience with NextGen
• Coding compliance program implementation experience

Required Skills/Knowledge/Abilities

• Knowledge of  Medicare, Medi-Cal/Presumptive Eligibility, FPACT, Every Woman Counts, Tricare and Managed Care Payors
• Knowledge of payor coding policies and guidelines for FQHC’s
• Familiar with medical terminology and strong data entry skills

To apply visit: www.vcc.org

And click on “Find a Job” link in the upper left hand corner.