HCC Quality Auditor (TEMP)

Virtix Health, LLC.; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Virtix Health is seeking a remote HCC Coding Quality Specialist to review coded records for accuracy, focusing on mappings to HCCs and RxHCCs. You will support findings using Medicare ICD-10-CM guidelines and client-specific rules, while helping train others and maintaining high quality metrics.

Required are at least 3 years in HCC coding with 2 years auditing, certification through AAPC or AHIMA, and experience with EMRs, billing systems, and abstraction platforms.

Qualifications

• Must be certified through AAPC or AHIMA (CPC, CRC, CCS, or CCS-P).
• Minimum 3 years HCC coding experience with 2 years auditing experience.
• Working knowledge of EMRs, billing systems, and abstraction platforms.

Responsibilities

• Review accuracy of HCC coded records, including mappings to HCCs and RxHCCs.
• Support findings with Medicare ICD-10-CM guidelines and client guidelines.
• Maintain a quality score of 95%+ and productivity targets; assist with training materials.

Skills

HCC coding experience

Auditing experience

Medicare guidelines

Education

AAPC or AHIMA certification (CPC/CRC/CCS/CCS-P)

Tools

EMRs

Billing systems

Abstraction platforms

Job description

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY: ESSENTIAL DUTIES AND RESPONSIBILITIES:

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Job Description Summary HCC Coding Quality Specialist Team Members will be responsible for reviewing the accuracy of our HCC coded records, specifically those that map to HCCs and RxHCCs. Auditors will support their findings utilizing Medicare guidelines, ICD-10-CM guidelines as well as client specific Ensure that the codes captured are supported by the documentation within the record and are properly coded following Medicare guidelines, ICD-10-CM guidelines as well as client specific guidelines for the project. Support your findings in a way the coder can easily identify and learn from the error. Have strong and professional communication skills. Be a resource for HCC coding team members by having a deep understanding of the project and coding guidelines. Follow Risk Adjustment Data Abstraction Rules. Assist with the creation of PowerPoints presentations for training purposes. Will be required to maintain a quality score of 95% or higher. Will be required to maintain an ongoing productivity level based on project requirements. Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information. Align conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and support the Company’s Ethics and Compliance Program. Comply with all internal policies and procedures. Regular, predictable, and punctual attendance is required.

Qualifications:

All auditors MUST be certified through either the AAPC or AHIMA. (Apprenticeship designations are not accepted.) Acceptable credentials would be CPC, CRC, CCS, or CCS-P. Must have at least 3 years of HCC coding experience with 2 years of auditing experience. Global experience preferred. Must have working knowledge and experience with systems such as EMRs, Billing systems, abstraction platforms, etc.

PHYSICAL DEMANDS:

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This is a remote position.

Virtix Health partners with health plans across the country to drive clinical, financial, and operational results. Virtix Health offers virtual wellness visits, in-home health risk assessments, retrospective chart review, HCC Coding, medical record repository, retrieval workflow technology, health risk assessments, and member engagement services.