Coding Auditor - Sharp Health Plan Administration - Telecommuter - Day Shift - Full Time

Hours:

Shift Start Time:

8 AM

Shift End Time:

5 PM

AWS Hours Requirement:

8/40 - 8 Hour Shift

Additional Shift Information:

Weekend Requirements:

No Weekends

On-Call Required:

No

Hourly Pay Range (Minimum - Midpoint - Maximum):

$33.090 - $42.700 - $52.310

 

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices. 

 

What You Will Do
Provides administrative and coding support to management, the department, and internal or external customers. Identifies and reports documentation and coding opportunities and makes recommendations for improved code capture and reporting. Monitors and reports coding trends. Supports data validation audits and immediately communicates coding discrepancies to management; works to improve overall provider accuracy.

Required Qualifications

• High School diploma or equivalent
• 3 years' experience working as a certified coder.
• 2 years' experience working as an HCC risk adjustment coding auditor.
• Experience with medical billing, medical terminology, understanding of medical records/medical notes, etc.
• Certified Professional Coder (CPC) - AAPC OR Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) -REQUIRED

Preferred Qualifications

• Certified Risk Adjustment Coder (CRC) - American Academy of Professional Coders (AAPC) -PREFERRED
• Registered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) - PREFERRED

Essential Functions

• Coding and Compliance
  Identifies areas of potential coding, billing and documentation deficiencies. Provide suggestions to resolve areas of deficiencies to management.
  Conducts audits and gap analysis then develops and implements action plans to address issues identified through the audit/analysis.
  Identifies areas of potential compliance risk and notify management immediately.
  Identifies anomalies in coding.
  Identifies ways to avoid errors and issues and creates safeguards to prevent them from happening again.
  Identifies coding trends and risk.
  Ensures the accuracy of all work.
• Act as a Resource
  Requests, reviews and codes medical services from reports and notes in order to convert procedural and diagnostic notes into appropriate levels of care following coding rules and regulations.
  Applies understanding of Medicare, Medi-Cal, and/or ACA and other payor guidelines.
  Identifies documentation deficiencies and recommends methods for resolution that satisfy regulatory and compliance requirements.
  Performs medical chart audits meeting minimum department productivity standards. Exercises mature judgment and maintains confidentiality in all activities.
  Compiles findings for clinician education on specific coding issues, HCC/Risk Adjustment coding guidelines, and documentation improvement.
  educate clinician and staff on coding updates, issues, documentation requirements, and processes when necessary.
  Serves as a key resource for documentation requirements for risk adjustment HCCs, RAF, and/or quality measures. Develop and build relationships with internal and external customers to achieve improvements in risk adjustment documentation, quality measures, data validations, as well as program participation.
• Data Collection and Reporting
  Maintains knowledge of coding software, databases, EHRs and other applications utilized in the department.
  Increase knowledge of electronic data systems and reporting tools to enhance value.
  Design and develop special reports within a specified timeframe.
  Participate in job related conferences, seminars and workshops.
  Review various coding publications for changes and relay information to pertinent parties.
  Identifies P4P metrics documentation.
• Process Improvement
  Independently researches coding questions, documents findings, makes recommendations and provides documentation that supports the recommended solutions.
  Provides professional and courteous support to clinical providers through email, phone and in-person contact, answering questions and providing supporting documentation.
  Provides timely and accurate answers to inquiries presented by customers on clinical coding issues.
  Maintain a positive attitude and p