After School R1 Rcm Medical Coding Jobs in Gilbert, AZ

Our client is seeking an experienced Quality Assurance Coder/Auditor in Phoenix, AZ on a Hybrid basis. This opportunity will transition from a 6-month contract to direct hire position while being trained as a replacement by a seasoned employee. The Quality Assurance Coder/Auditor will develop a risk mitigation and provider education program. The Quality Assurance Coder/Auditor will perform risk mitigation analysis using available vendor tools to identify at-risk single occurrence of HCCs and OIG targets.

Schedule: 40 hours a week (plus any additional hours as requested or as needed to meet business requirements).

Hybrid: 1 day a week in office setting, remainder of week is remote

Key Responsibilities:

• Comprehensive understanding of HCC Coding rules, regulations and methodology

• Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements

• Determine valid encounters, including face-to-face, legibility and valid signature, according to Medicare Managed Care requirements

• Track QA audits and send out monthly updates to Vendor and management team. Updates include report findings and recommendations regarding closing healthcare gaps, medical record documentation, coding, and additional educational training to management. The goal is >95% accuracy in QA audits

• Accurately and efficiently conduct medical record review/abstraction services

• Develop effective provider/coder education program in support of risk mitigation analysis.

• Travel to physician offices, conduct on-site educational training on how to close identified health care gaps, accurately document in medical record, and submit claims with correct coding. Track educational training sessions by date, provider, topic, number of attendees, etc.

• Other duties as assigned

• Maintain current knowledge of the Medicare Managed Care Manual, Chapter 7 - Risk Adjustment and Medicare outpatient billing systems/processes

• Maintain coding certification, and stay current with the numerous changes in risk adjustment methodologies

Competencies:

• Excellent understanding of the CMS crosswalk of ICD diagnosis codes to Hierarchical Condition Category (HCC) codes and impact of diagnosis coding on risk adjustment payment models

• Sufficient knowledge of anatomy, pathophysiology, and medical terminology necessary to correctly code diagnoses according to CMS and ICD-10 coding guidelines

• General knowledge of the provisions contained in Chapter 7 – Risk Adjustment, Medicare Managed Care Manual

• Computer proficiency in an MS-Windows environment, including MS Word, Excel, and PowerPoint, and ability to learn organizational systems and software applications

• Basic knowledge and understanding of primary care provider office practices, electronic and manual medical record systems, and billing processes

• Ability to develop training materials and conduct educational training to close healthcare gaps, improve medical record documentation, and ensure complete and accurate coding

Strong understanding of the Risk Adjustment Validation Audit (RADV) process for risk adjustment models

• Pharmacology knowledge

Required Qualifications:

• 5 years of professional coding experience, with at least 3 years of HCC coding experience. Advanced knowledge of coding guidelines

• High School Diploma or GED in general field of study

• Certified Coding Specialist – Physician Based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC), or Certified Outpatient Coding (COC) credential

PREFERRED QUALIFICATIONS:

• 5 years of Medicare Advantage health plan experience

• 5 years of experience with HEDIS measures and/or the CMS Star Program

• Clinical training (Medical Assistant, Registered Nurse, Licensed Practical Nurse, or Certified Nursing Assistant)

• Registered Health Information Technologist (RHIT) or Registered Health Information Administrator (RHIA)

• Certified Documentation Expert Outpatient (CDEO)Certified Professional Medical Auditor (CPMA)