HealthTexas Medical Group of San Antonio
  • Accurate Coding Initiative (ACI)
  • San Antonio, TX, USA
  • Full Time

Job Title: HCC Auditor/Coder

Reports To: Clinical Coding Manager

FLSA Status: Exempt

Job Summary

The HCC Auditor/Coder will review medical records for accurate code selection, to include highest level of specificity, documentation validation, compliance with ICD-10 coding guidelines, and quality of care opportunities.

Role responsibilities:

  • Reviews outpatient medical records on both a retrospective and prospective basis to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives.
  • Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure.
  • Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.
  • Safeguards medical records and preserves the confidentiality of personal health information.
  • Keeps current on changes in coding and reimbursement requirements for government programs and other third party payers.
  • Ensures compliance with all applicable Federal and State laws and regulations related to coding and documentation guidelines for Risk Adjustment.

Knowledge, Skills & Abilities

  • Risk Adjustment methodology experience preferred
  • Proficient knowledge of CMS-HCC Model and guidelines
  • Ability to interpret, analyze and abstract data/documentation
  • Ability to identify HCC improvement opportunities and provide feedback to physicians on proper clinical documentation, compliance, and coding guidelines
  • Excellent organization and problem-solving skills required.
  • Strong oral and written communication skills required.
  • Strong time management skills required.
  • Ability to work in a continuously changing environment.
  • Must possess a high degree of accuracy, efficiency and dependability.
  • Ability to work effectively as a team member.

Experience & Education

  • Must have a minimum of 3 years coding experience with at least 1 year HCC Risk Adjustment experience and successful completion of a coding certificate program from one of the following is required: Certified Professional Coder (CPC); or Certified Coding Specialist - Physician (CCS-P)
  • High School diploma or equivalent required. Bachelor's degree in related field preferred; and/or relevant equivalent and relevant work experience preferred.

Supervisory Responsibility: None

Working Conditions/Physical Requirements:

Requires working under stressful conditions where constructive criticism from others is encouraged. Requires working extended or irregular hours (including evenings and occasional weekends) as the medical group determines necessary or desirable to meet its business needs and/or the needs of its patients. Requires prolonged sitting, some bending, stooping and stretching and occasional lifting up to 50 pounds. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Normal office environment.

HealthTexas Medical Group of San Antonio
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