|Employer:||HealthTexas Medical Group
|Required Experience:||3 to 4 years
|Preferred Experience:||3 to 4 years
|Location:||2961 Mossrock San Antonio 78230, TX, US
The HCC Auditor/Coder
will review medical records for accurate code selection, to include highest
level of specificity, documentation validation, compliance with ICD-10 coding
guidelines, and quality of care opportunities.
- Reviews outpatient medical records on both a
retrospective and prospective basis to ensure
documentation accurately reflects and supports code selection based on the
ICD-10 coding guidelines, which are submitted to CMS for reimbursement
based on the CMS Hierarchical Condition Categories (HCC) conditions that
are applicable to Medicare Risk Adjustment reimbursement initiatives.
- Performs physician
queries as needed in order to validate ICD-10 diagnosis codes and follows
established physician query policy and procedure.
- Ensures the diagnosis codes for each chronic or
major medical condition have been captured and submitted within the
permitted CMS timeframe.
- Safeguards medical records and preserves the
confidentiality of personal health information.
- Keeps current on changes in
coding and reimbursement requirements for government programs and other
third party payers.
- Ensures compliance with all
applicable Federal and State laws and regulations related to coding and
documentation guidelines for Risk Adjustment.
Knowledge, Skills & Abilities
· Risk Adjustment
methodology experience preferred
· Proficient knowledge
of CMS-HCC Model and guidelines
· Ability to interpret,
analyze and abstract data/documentation
· Ability to identify
HCC improvement opportunities and provide feedback to physicians on proper
clinical documentation, compliance, and coding guidelines
· Excellent organization
and problem-solving skills required.
· Strong oral and
written communication skills required.
· Strong time management
· Ability to work in a
continuously changing environment.
· Must possess a high
degree of accuracy, efficiency and dependability.
· Ability to work
effectively as a team member.
Experience & Education
School diploma or equivalent required. Bachelor’s degree in related field
preferred; and/or relevant equivalent and relevant work experience
- Must have a minimum of 3 years coding
experience with at least 1 year HCC Risk Adjustment experience and
successful completion of a coding certificate program from one of the
following is required: Certified
Professional Coder (CPC); or Certified Coding Specialist - Physician