Risk Adjustment Coding Auditor II (AAPC or AHIMA coding certification required)

Job Summary:

The Risk Adjustment Coding Auditor II is responsible for performing over-reads of vendor ICD-10 coding, reviewing provider documentation supplied to them, and diagnostic codes assigned by vendor.

Essential Functions:

• Meets assigned volume metrics
• Validates the accurateness of ICD-10 codes assigned by the vendor
• Tracks the trends and reports on the findings
• Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products
• Participates in quality coding initiatives as appropriate or assigned
• Maintains knowledge of AHA Coding Clinic and ICD-10 Official Guidelines for Coding and Reporting
• May be asked to perform over reads of provider coding/documentation
• Meets deadlines and works independently on multiple projects
• Perform any other job duties as requested

Education and Experience:

• High School Diploma or GED is required
• Minimum of three (3) years of diagnostic coding experience and a firm understanding of ICD-10 is required
• A minimum of three (3) years of experience in auditing medical records is required
• Risk Adjustment methodology experience required

Competencies, Knowledge and Skills:

• Intermediate level with Microsoft Word, Microsoft Outlook, Microsoft Excel
• Ability to work in a fast paced production environment while maintaining high quality
• Knowledgeable and experienced with researching  CMS and other sites for Risk Adjustment guidance
• Exceptional knowledge of medical coding and regulatory requirements
• Knowledgeable of Medicaid, Medicare, Exchange
• Knowledgeable of ICD-10
• Ability to make independent decisions on ICD 10 code assignments
• Excellent verbal and written communication skills
• Ability to effectively interface with teammates, vendors and management
• Ability to work with others and work independently
• Possesses critical thinking/listening skills
• Strong interpersonal skills and high level or professionalism
• Detail oriented
• Facets training/knowledge is preferred

Licensure and Certification:

• AAPC or AHIMA coding certification is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business