Coding Auditor I - Risk Adjustment, SWHR

Education

• Associate's Degree, completion of an accredited Coding program required.
• 2 years of relevant work experience in lieu of degree required.

Experience

• Require minimum of 1 year of experience in medical records review, documentation, and coding, preferably in an ambulatory physician setting with an Associate’s Degree, OR,
• Require a minimum of 3 year of experience in medical records review, documentation, and coding preferably in an ambulatory physician setting without an Associate’s Degree.
• Require experience interpreting all types of medical records, including physician documentation.
• Require comprehensive knowledge of ICD-9 and ICD-10.

• Prefer Hierarchical Condition Category (HCC) Coding experience.

Licenses and Certifications

• Require a current Certified Professional Coder (CPC) Certification or Certified Professional Coder – Apprentice (CPC-A) Certification from the American Academy of Professional Coders (AAPC) upon hire date.

Skills & Abilities

• Strong time management skills required.

 ◦ Personal discipline to work remotely without direct supervision.

 ◦ Ability to remain productive under time constraints and meet deadlines critical to the business.

• Ability to navigate within various EMRs (Electronic Medical Records).
• Working knowledge of medical terminology, anatomy, and physiology.
• Intermediate skills in Microsoft Outlook, Word, and Excel.
• Strong interpersonal, communication (verbal, non-verbal and listening) skills.
• Exemplary attention to detail and completeness.
• Strong organization, interpersonal, and customer service skills.
• Must be able to audit a minimum of 25 charts per day.
• Must be able to maintain Quality Assurance score of 95% or greater.
• Must be able to follow internal and external coding guidelines, policies and procedures.

Position Responsibilities

The Coding Auditor I support Southwestern Health Resources' comprehensive Risk Adjustment Coding and Auditing program. The Coding Auditor I will be responsible for, but not limited to, coding, confirming, and abstracting diagnosis codes from medical record reviews and ensuring physician documentation practices comply with CMS Risk Adjustment requirements, as well as ICD-10-CM Coding Guidelines.

Position Functions

• HCC Chart Audits and Projects:

• Ability to code using an ICD-10-CM code book.

• Abstract clinical data from health records and assign appropriate ICD-10-CM codes, mapping to applicable HCC models.

• Perform outpatient clinical documentation improvement queries based on provider documentation as needed.

• Knowledge of HIPAA, recognizing a commitment to privacy, security, and confidentiality of all medical records.

• Meet production goals set by team supervisor for HCC chart audits (minimum 25 charts per day), form review, etc. while maintaining ≥ 95 accuracy.

• Assist in monitoring problems related to claims data in capturing HCC codes.

• Maintain tools, methods and standards for HCC coding and documentation.

• Daily crosschecking to meet quality standards.

• Meet projects with month end deadlines.

• Perform other job duties as assigned.

• Must be able to follow internal and external coding guidelines, policies, and procedures.
• Education:

• Provide education based on chart review results and any annual changes from CMS in regard to Risk Adjustment.

• Responsible for all education requests for assigned clinics

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org