Concurrent RADV Coding Auditor (remote)

Concurrent RADV Coding Auditor

Full Time (Monday-Friday 8AM-5PM)

Remote position

Millennium Physician Group is seeking to hire a full-time Concurrent RADV Coding Auditor to join our team . We are looking for a new team member who is -positive, energetic, able to multi-task, and loves patient interaction. We want someone who supports our top initiative of ensuring an excellent patient experience!

In a concurrent coding review process, the Concurrent Risk Adjustment Documentation Validation (RADV) Coding Auditor is responsible for reviewing the encounter level patient medical record and provider selected ICD-10-CM diagnosis codes in real time prior to claim submission. Concurrent RADV Coding Auditors will leverage existing EHR tools and other technologies to validate completeness and accuracy of provider selected ICD-10-CM codes as well as abstract and assign ICD-10-CM diagnosis codes supported in the encounter documentation not initially assigned to the encounter claim by the rendering provider. This concurrent review aims to ensure the diagnosis codes assigned to the encounter claim accurately support the health status of the patient at the time of the encounter supported by provider documentation in the EHR.

Concurrent RADV Coding Auditors will work in tandem with other members of the MRA Department such as prospective review and provider education teams to support shared initiatives. This role is expected to maintain a consistent coding accuracy rate of 95% or higher and able to meet productivity standards established by leadership.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• • Maintains active professional certification and complies with all educational, professional, and ethical requirements of said certification.
  • Demonstrates knowledge of health systems operations, including an understanding of reimbursement methodologies and coding conventions.
  • Demonstrates ability to perform accurate and complete encounter level reviews for Hierarchical Condition Categories (HCC)/Risk Adjustment.
  • Possesses advanced knowledge and understanding of HCC/Risk Adjustment, coding and documentation requirements.
  • Ensures all diagnoses are accurate and complete from the patient encounter in accordance with the ICD-10-CM Official Guidelines for Coding and Reporting.
  • Demonstrates ability to identify and communicate trends in provider coding and documentation.
  • Delivers clear, concise, and professional communications to providers as necessary when documentation is inadequate, ambiguous, or otherwise unclear for medical coding purposes.
  • Responsible for documenting and tracking queries to providers in identified database.
  • Possesses excellent written, verbal, communication and attention to detail skills.
  • Reviews patient encounters to identify chronic and currently treated conditions, ensuring that official coding guidelines are followed.
  • Abstracts and/or validates the appropriate ICD-10-CM diagnosis code to the highest level of specificity supported in the patient record is present on the encounter claim prior to submission.
  • Consistently maintains productivity and accuracy standards set by leadership.
  • Stays current on applicable coding and documentation guideline changes and rules.
  • Works effectively and efficiently within a team environment.
  • Adaptable to shifting priorities and demonstrates willingness to do what it takes to meet team needs.
  • Understands and complies with policies and procedures for confidentiality of all patient records, HIPAA, and security of systems.
  • Promotes Millennium Physician Group's values.
  • Ability to work independently, under the supervision of department leadership.
  • Perform other job-related duties as may be assigned or required.

• Education and/or Experience

  Required Minimum Education/Experience:

  • High school diploma or GED equivalent
  • Minimum 2 years' experience working in payor or healthcare related field
  • Certified Procedural Coder (CPC) minimum acceptable coding-related credential. Preference given to those with CRC designation.
  • Additional acceptable credentials include: Certified Documentation Expert Outpatient (CDEO) or other AAPC or AHIMA approved coding credential

  Preferred Education/Experience

  • Preferred three to five years' HCC coding experience

Benefits:

• 3 weeks PTO & 7 paid holidays
• Medical, Dental, Vision
• Employer Paid Basic Life & Short Term Disability coverage (goes into