Job Description - HCC Auditor and Educator Onsite San Antonio

• CPC, CRC, CCS, CCS-P, RHIT, RHIA. 5+ years of Risk Adjustment experience, someone who has experience with presenting the findings on improper documentation.

The HCC Auditor will do a review of medical records to determine the completeness and accuracy of HCC coding by ensuring that the assigned codes and HCC codes are supported by clinical documentation. Ask the candidate to tell what a typical day consists of as a HCC Auditor and have them include any education they may provide to the physician or staff.

Potential Responsibilities:
Reviews medical records to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure. Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.

- Reviews patient records for accuracy in HCC ICD-10-CM coding. Ask the Candidates to provide a couple of errors they find when performing these audits.

- Provide education and training to physicians, and appropriate office staff on correct coding protocol and guidelines---Ask the candidate to tell you about an educational or training session they presented to the Physicians and/or staff.

Average Qualifications:

- Required: 2-5 years' experience with code validation experience and knowledge of Medicare HCC coding protocol required

Certification -

Required: Coding Certification from AAPC or AHIMA
- Certified Professional Coder (CPC); or
- Certified Coding Specialist - Physician (CCS-P) or
- Certified Coding Specialist (CCS)

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