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Company Name : Intermountain Healthcare
Location : Murray, UT
Position : Risk Adjustment Coding Auditor I
Job Description : Job Description:
Audits medical records to ensure accurate and complete documentation and coding according to general medical coding guidelines and risk adjustment guidelines as established by the Centers for Medicare and Medicaid (CMS) and Health and Human Services (HHS) for highly-regulated government insurance programs such as Medicare Advantage (MA), Medicaid and the Affordable Care Act (ACA).
Scope
Works under direct supervision.
Job Essentials
1. Ensures ICD codes that are submitted to CMS for the Risk Adjustment Payment System are accurate, appropriate, and supported by written clinical documentation in accordance with all Federal and State regulations and internal policies and procedures.
2. Reviews results of risk adjustment coding validation to identify coding patterns and recommends general and specific provider education topics based on CMS/HHS guidelines.
3. Maintains knowledge of coding work flow and use of available technology.
4. Documents audit results in a risk adjustment database for reporting purposes.
5. Participates in governmental risk adjustment audits for CMS/HHS on a limited basis.
6. Effectively manages workload and responsibilities.
7. Complies with HIPAA law to maintain data privacy and security.
8. Completes all continuing education requirements needed for certifications earned on an ongoing basis.
9. Works with software programs (e.g., spreadsheets, databases, word processing, coding programs, and Electronic Medical Records (EMR)).
10. Functional knowledge of general medical terminology, medical acronyms, anatomy, and physiology.
Minimum Qualifications
Coding certification from AAPC or AHIMA.
One year of work or educational experience reviewing medical records for accurate and complete coding/documentation.
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One year of work or educational experience with current ICD-CM coding.
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Experience with claims processing system, coding programs, and Electronic Medical Records (EMR).
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Experience with software programs such as spreadsheets, data base, and word processing.
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Demonstrated sound judgment and decision making skills.
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Demonstrated excellent organizational, analytical, and communication skills.
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Demonstrated ability to learn and adapt to changes in risk adjustment methodology.
Preferred Qualifications
Coding certification from AAPC or AHIMA
Knowledge of ICD-CM coding.
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Completion of the Certified Risk Adjustment Coder (CRC) certification. Certificate must be completed no later than within one year of hire.
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Completion of an internal CRC training and competency evaluation no later than within one year of hire.
Physical Requirements:
Interact with others requiring the employee to communicate information.
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Required ability to move fingers and hands to operate computers and other office equipment.
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See and read computer monitors and documents.
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Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Location:
Employee Service Center
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
This post is listed Under Utah jobs
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