Coding Quality Auditor

This is a fully remote position, open to applicants in Washington.

📋 Description

• Perform comprehensive diagnostic chart evaluations of clinical documentation and coding associated with Risk Adjustment and HCC coding.

• Review and extract HCC codes to ensure precise and highly specific coding.

• Engage with providers to clinically validate or clarify diagnosis criteria.

• Examine documentation for compliance in reporting, billing, and RVU capture.

• Act as a coding expert within the team.

• Collaborate with the Quality Integrity Program manager and the clinical documentation review team.

• Maintain compliance with the Official Coding Guidelines for Coding and Reporting, along with coding conventions and regulatory oversight standards.

⛳️ Requirements

• Minimum of 2 years of experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVUs.

• Proficient in reviewing patient account details, insurance explanations of benefits, computer screens, and financial records.

• Within one year of hire: Certification as a Professional Coder (CPC) or Certified Coding Specialist (CCS) is required.

• A bachelor’s degree is preferred or equivalent education/experience.

• Within one year of hire: Certification as a Certified Risk Adjustment Coder (CRC) is preferred.

• Within one year of hire: Certification as a Certified Professional Medical Auditor (CPMA) or Certified Healthcare Compliance Auditor (CHCA) is preferred.

• Experience in HCC coding is preferred.

🏝️ Benefits

• Retirement 401(k) Savings Plan with employer matching.

• Comprehensive health care benefits (medical, dental, vision).

• Life insurance coverage.

• Disability insurance.

• Paid parental leave.

• Vacation and holiday time off.

• Health-related time off benefits.

• Voluntary benefits options.

• Access to well-being resources.

• An inclusive workplace with equal opportunities for advancement.