Job Description
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:
$53,400.00 - $85,600.00 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
Competencies:
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
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CareSource is an equal opportunity employer and gives consideration for employment to qualified applicants without regard to race, color, religion, sex, age, national origin, disability, sexual orientation, gender identity, genetic information, protected veteran status or any other characteristic protected by applicable federal, state or local law.
