Offer summary

Qualifications:

Associate's degree or 2 years of relevant work experience required., 2 years of experience in risk adjustment auditing or coding is necessary., Certification in coding (CCS, CCS-P, CPC, RHIA, or RHIT) is required., Knowledge of ICD-10-CM, CPT coding conventions, and clinical documentation is essential..

Key responsabilities:

Conduct provider audits and create scorecards to provide feedback on risk adjustment methodology.

Interpret health record documentation to code and abstract diagnoses and procedures for various cases.

Perform focused HCC reviews, track results, and identify trends for follow-up.

Assist with educator duties in clinics and maintain patient confidentiality and data integrity.

Job description

Job Summary

Accountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health risk adjustment strategies and processes for lines of business subject to risk adjustment.

Salary Range

The pay range for this position is $26.66/hr (entry-level qualifications) - $40/hr (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.

Essential Functions Of The Role

Conducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology
Interprets health record documentation to code and abstracts diagnoses and/or procedures for inpatient, outpatient, and clinic cases
Conducts focused HCC reviews on providers and clinics, tracks results and identifies trends and deficiencies for follow-up
Researches complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and the Federal Register, and sharing knowledge with co-workers, as directed
Assists Risk Adjustment Auditor 2 or Manager with educator duties in the clinics on occasional based, as needed
Protects data integrity and validity
Maintains and respects patient confidentiality for accessing and disclosure of health information

KEY SUCCESS FACTORS

Knowledge of ICD-10-CM and CPT coding conventions, and clinical documentation
Knowledge of and compliance with standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC)
Knowledge of anatomy, physiology, pathological processes of disease, and medical terminology
Critical thinking skills for chart review and abstraction
Efficient Time Management skills
Proficiency in use of Microsoft applications such as Word, Excel, and PowerPoint preferred

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

Immediate eligibility for health and welfare benefits
401(k) savings plan with dollar-for-dollar match up to 5%
Tuition Reimbursement
PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

Qualifications

EDUCATION - Associate's or 2 years of work experience above the minimum qualification
EXPERIENCE - 2 Years of Experience

CERTIFICATION/LICENSE/REGISTRATION

Cert Coding Specialist (CCS), Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Reg Health Info Administrator (RHIA), Reg Health Information Technic (RHIT): Must have one of the following:
CCS - Certified Coding Specialist
CCS-P - Certified Coding Specialist-Physician Based
CPC - Certified Professional Coder
RHIA - Reg Health Info Administrator
RHIT - Reg Health Information Technician.

Required profile