Coding Quality Auditor
Responsible for performing audits of medical records to ensure the ICD-10 codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the Risk Adjustment Payment System (RAPS) are appropriate, accurate, and supported by written clinical documentation in accordance with all state and federal regulations and internal policies and procedures.
- Performs audits of medical records to ensure all assigned ICD-10 codes are accurate and supported by written clinical documentation.
- Provides education to internal staff and external providers based on audit findings; provides general education on ICD-10 codes as appropriate.
- Effectively communicates the audit process and results to the appropriate departments and management.
- Assists senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded and operational efficiency and financial accuracy can be achieved.
- Maintains current knowledge of ICD-10 codes, CMS documentation requirements, and state and federal regulations.
- Performs other related duties as required.
Required Qualifications :
- Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
- Experience with ICD-10 codes required.
- Experience with Medicare and/or Medicaid Risk Adjustment process required
- CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician).
- Required Minimum of 2 years recent and related experience in medical record documentation review, diagnosis coding, and/or auditing.
- Excellent analytical and problem solving skills Effective communications, organizational, and interpersonal skills.
- High School Diploma or G.E.D.
Please review required qualifications above
High School diploma, G.E.D. or equivalent experience
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