Risk Adjustment Coding Auditor II (CPC required)

Job Summary:

The Risk Adjustment Coding Auditor II is responsible for performing over-reads of vendor ICD-10 coding, reviewing provider documentation supplied to them, and diagnostic codes assigned by vendor.

Essential Functions:

• Meets assigned volume metrics
• Validates the accurateness of ICD-10 codes assigned by the vendor
• Tracks the trends and reports on the findings
• Demonstrates a thorough understanding of Risk Adjustment hierarchical condition categories (HCCs), for all risk adjusted products
• Participates in quality coding initiatives as appropriate or assigned
• Maintains knowledge of AHA Coding Clinic and ICD-10 Official Guidelines for Coding and Reporting
• May be asked to perform over reads of provider coding/documentation
• Meets deadlines and works independently on multiple projects
• Perform any other job duties as requested

Education and Experience:

• High School Diploma or GED is required
• Minimum of three (3) years of diagnostic coding experience and a firm understanding of ICD-10 is required
• A minimum of three (3) years of experience in auditing medical records is required
• Risk Adjustment methodology experience required

Competencies, Knowledge and Skills:

• Intermediate level with Microsoft Word, Microsoft Outlook, Microsoft Excel
• Ability to work in a fast paced production environment while maintaining high quality
• Knowledgeable and experienced with researching  CMS and other sites for Risk Adjustment guidance
• Exceptional knowledge of medical coding and regulatory requirements
• Knowledgeable of Medicaid, Medicare, Exchange
• Knowledgeable of ICD-10
• Ability to make independent decisions on ICD 10 code assignments
• Excellent verbal and written communication skills
• Ability to effectively interface with teammates, vendors and management
• Ability to work with others and work independently
• Possesses critical thinking/listening skills
• Strong interpersonal skills and high level or professionalism
• Detail oriented
• Facets training/knowledge is preferred

Licensure and Certification:

• AAPC or AHIMA coding certification is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.