HCC Coder/Auditor

Job Summary

The HCC Coder/Auditor reviews services provided and compares them to EHR and billing records to determine accuracy. The HCC Coder/Auditor is responsible for performing quality reviews of outpatient medical records to validate the integrity of ICD9/ICD-10 diagnoses and procedures as well as CPT/CPT II coded procedures. The HCC Coder/Auditor reviews medical records and other documentation to identify under and over coded services, prepares reports of findings and meets with management to educate on and improve coding practices. The HCC Coder/Auditor ensures appropriate coding and maintains compliance documentation. The HCC Coder/Auditor ensures that billing is optimized, and errors are minimized by identifying opportunities through audit and observation. The HCC Coder/Auditor remains abreast of regulatory and procedure changes which may affect coding compliance and /or reimbursement.

Work Performed and Job Requirements

• Determine daily assignment through established department process.
• Access designated client system to Code and or Audit medical records using Official Coding and Documentation Rules and Guidelines and document findings.
• Complete internal and or Client Spreadsheet and or Database, making sure that all columns are complete and accurate.
• Account for time throughout the day according to project by accurately recording tasks in Timekeeping System.
• Reference required department specific instructions to ensure proper policy is followed.
• Provide oral or written rationale to the Client regarding improvements needed in documentation.
• Develop and maintain personal system to ensure internal and client access stay current.
• Report internal and Client IT outages through established ticket submission process.
• Remain current on all changes to coding/documentation guidelines pertinent to assigned department.
• Follow HIPAA regulations and remain current on HIPAA training.
• Author articles for company newsletter.
• Prepare and Present Client and Internal Education and Quality Presentations.
• Update and maintain accurate productivity and Quality records.
• Update and Edit company school and or curriculum as required.
• Willing to work weekends or holidays, depending on client demands.
• Provide periodic quality and new content reviews for company Curriculum.
• Other duties as assigned.

Education/Training

Minimum of a High School diploma and current certification from AHIMA or AAPC required.

Experience

Minimum of 1 year of experience as a Medical Coder and/or Auditor required.

Knowledge, Skills, and Abilities

• Knowledge of medical terminology and Microsoft products.
• Knowledge and prior exposure to ICD-10CM and ICD-10 PCS.
• Ability to read, analyze and interpret complex medical records using official documentation and coding guidelines.
• Ability to communicate fluently in writing and verbally in the English language.
• Ability to perform simple Math, reading and deductive reasoning.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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