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Perks: Flexible, full time schedule Stable and ongoing consulting position $30-40 an hour Equipment provided World-class training and technology Job Description The Risk Adjustment Coding Auditor will be responsible for conducting documentation reviews to assess the accuracy, completeness, and highest ICD-10 specificity related to risk adjustment and HCC coding guidelines, and assist educating in medical necessity coverage of diagnostic studies.
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Expertise in CMS Risk Adjustment Data Validation (RADV) for Medicare Advantage Plans, and medical coding, including but not limited to E/M, ICD-10, CPT, and HCC coding preferred. An equivalent combination of Risk Adjustment Coding work experience and other relevant American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) certification may be substituted for the stated certification requirements.
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Responsibility for maintaining coding certification and referencing current ICD-10 coding guidelines and regulatory changes. AAPC, AHIMA or Certified Coding credential (excludes apprenticeship classification.
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Conducts coding reviews independently on all provider documentation to assign the correct ICD-10 codes and ensure all documentation is accurate, precise, and adherent to CMS guidelines pertinent to Risk Adjustment Hierarchical Condition Category (HCC) methodology.
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Performs multi-specialty reviews for the Medical Group validating the CPT, ICD-10, modifiers and HCPCS codes using official coding guidelines and CMS guidelines and prepares a summary of findings.
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Inpatient Coder IIs will evaluate inpatient medical records and accurately assign the appropriate ICD-10 CM/PCS codes, Present on Admission (POA) indicators, and relevant DRGs. The Coder II must be skillful in the identification and assignment of all diagnoses and procedures in accordance with nationally recognized coding guidelines, as well as researching opportunities to improve documentation.
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Assigns appropriately sequenced and compliant ICD-10 CM/PCS codes as documented in the electronic medical record (EMR). Extensive knowledge of ICD-10 guidelines and coding regulations.
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Medical Coding including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), International Classification of Diseases (ICD-10) and Diagnosis-related Group (DRG) Codes.
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Advanced knowledge of disease processes, ICD-10, CPT and HCPCS coding applications, clinician documentation, and HIM department responsibilities of government regulations and areas of scrutiny for potential fraud and abuse.
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A minimum of 10 or more years of progressively responsible and advanced experience in healthcare coding with a combined 2 years or more of auditing experience in either facility of professional services coding.
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The incumbent is responsible for coding oversight of medical records to ensure the appropriate CPT codes, diagnostic codes and modifiers according to generally accepted medical coding guidelines, CPT; HCPCS; ICD-10 Guidelines; and, CMS Correct Coding.
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This position will participate in the development, implementation and performance of workflows for auditing electronic medical records aimed at improving the health and well-being of patients and proper identification of Chronic Disease Conditions as well as working to create a unique data and reporting model to capture and optimize ICD-10 reporting to Payers to improve quality for our patients and reduce healthcare costs.
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This includes knowledge of CPT, ICD-10, LCD/NCD and CCI experience. Minimum of 1 Coding Certification from AHIMA or AAPC; RHIA, RHIT, CPC, CCS,COC. Maintains coding knowledge and skills through attending continuing education activities and reviewing pertinent literature, attending institutional coding meetings, AAPC/AHIMA seminars, and other educational forums.
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Extensive hands-on ICD-10 CM / PCS experience required. National Coding Certification required through either AHIMA (preferred) or AAPC. The Diagnostic Related Groups (DRG) QC Clinical Auditor will be responsible for performing quality control DRG validation (clinical/coding) reviews of internal audit team reviews of medical records and/or other documentation to determine correct DRG/coding that is clinically supported as defined by review methodologies specific to the contract for which review services are being provided.
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Provides ICD-10 and CPT codes for Business Services and physician office requests regarding non-billed or non-reimbursed claims. AAPC=CCA, CIPC, COC, CPC or CRC OR. AAPC=CCA, CIPC, COC, CPC or CRC OR.
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