Coding Quality Auditor

Providence; Everett (WA); On-site; USD 70,000 - 95,000; Full time

Job summary

Join a culture focused on patient-centered care and collaboration, where your expertise helps maintain regulatory compliance and high-quality documentation across our care teams in Northwest Washington.

Qualifications

• 2 years of experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU's.
• Experience in reviewing patient account information, insurance explanation of benefits, computer screens, and financial records.
• Within 1 year of hire: CPC or CCS certification.

Responsibilities

• Perform detailed diagnostic chart reviews of clinical documentation and coding for Risk Adjustment and HCC coding.
• Query providers to clinically validate or clarify diagnosis criteria.
• Review for compliant documentation resulting in compliant reporting/billing and RVU capture.

Skills

Medical billing and coding

RVU review

Healthcare coding compliance

Education

Bachelor's Degree or equivalent

Job description

Under the supervision of the Coding Manager, Revenue Capture, the HCC Coding Quality Auditor is responsible for detailed diagnostic chart reviews of clinical documentation and coding associated with Risk Adjustment and HCC coding. The incumbent reviews and abstracts HCC codes to ensure they are coded accurately, to the highest specificity, queries providers to clinically validate or clarify diagnosis criteria, and reviews for compliant documentation resulting in compliant reporting/billing and RVU capture. Serves as a coding expert, working with the Quality Integrity Program manager and clinical documentation review team to ensure compliance with Official Coding Guidelines for Coding and Reporting, coding conventions and regulatory oversight agencies.

Providence caregivers are not simply valued - they're invaluable. Join our team atProvidence Medical Group Northwest Washington and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications:

• 2 yearsof experience in medical insurance reimbursement, medical billing, and coding related to charge review and work RVU's.
• Experienced in reviewing patient account information, insurance explanation of benefits, computer screens, and financial records.
• Within 1 year of hire: Certified Professional Coder (CPC) Or Certified Coding Specialist (CCS)

Preferred Qualifications:

• Bachelor's Degree. Or equivalent educ/experience
• Within 1 year of hire: Certified Risk Adjustment Coder (CRC)
• Within 1 year of hire: Certified Professional Medical Auditor (CPMA) Or
• Within 1 year of hire: Certified Healthcare Compliance Auditor (CHCA)
• Experience in HCC coding.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.