RISK ADJUSTMENT CODING AUDITOR II

Galen Medical; Chattanooga (TN); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

401(k) benefits

Education reimbursement

Holiday Pay

Paid time off

Life Insurance & Long Term Disability

Job summary

Galen Medical Group in Chattanooga is seeking a Risk Adjustment Coding Auditor II to review patient records and ensure accurate ICD-10-CM coding in accordance with CMS standards. You will collaborate with physicians and coding staff to improve documentation and reimbursement.

The role emphasizes documentation improvement, compliance with HIPAA and CMS regulations, and data accuracy. Candidates should have CRC and CPC certifications and 3–5 years of coding experience, with CMS-HCC modeling

Qualifications

• CRC and CPC certification required or active
• 3–5 years of clinical coding experience
• Familiarity with CMS-HCC models and ICD-10-CM coding

Responsibilities

• Review outpatient/inpatient records to identify chronic conditions and relevant data.
• Assign accurate ICD-10-CM codes ensuring HCCs are captured per MEAT criteria.
• Identify documentation gaps and provide actionable feedback to clinicians.
• Ensure compliance with HIPAA, CMS regulations and internal policies.
• Collaborate with providers and coding staff to improve documentation and coding accuracy.

Skills

ICD-10-CM coding

CMS-HCC models

Medical terminology

EMR systems

Problem-solving

Communication

CRC/CPC certification

Education

High-school Diploma or GED

Job description

Risk Adjustment Coding Auditor II

Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages.

Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor!

Summary/Objective:

The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes.

Essential Functions:

• Medical Record Review: Thoroughly analyze outpatient/inpatient medical records to identify chronic conditions, co-morbidities, and relevant diagnostic information.
• Accurate Code Assignment: Assign accurate ICD-10-CM codes, ensuring all relevant HCCs are captured according to the MEAT criteria (Monitoring, Evaluation, Assessment, Treatment).
• Documentation Improvement: Identify documentation gaps and provide actionable feedback to clinicians to enhance documentation specificity and completeness.
• Compliance Monitoring: Comply with HIPAA regulation, CMS regulations, and internal policies to ensure accuracy and reduce risk during audit inquiries.
• Data Accuracy: Ensure all assigned codes are supported by clinical evidence in the documentation and maintain high productivity and quality standards.

• Collaboration: Communicates with providers regarding coding best practices and documentation requirements.

Other Duties/Responsibilities:

• Protects self and other team members by following all compliance, HIPAA, and infection prevention guidelines and regulations.
• Respects patients by recognizing their rights; maintaining confidentiality.
• Maximize the use of resources to improve quality outcomes with the reduction of unnecessary tests/procedures, maintaining accurate and complete documentation in the medical record.
• May provide telephonic outreach to patients identified as high risk, with chronic condition(s) to assist with medical record requests, as needed.
• Thorough understanding of ICD-10, CPT, and complex co-morbidity coding.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices, and participating in professional organizations regarding clinical quality measures and governmental regulations.
• Other duties as assigned.

Knowledge/Skills/Abilities:

• Strong interpersonal skills.
• Strong understanding of ICD-10-CM coding, medical terminology, and CMS-HCC models.
• Basic understanding of medical office workflows, patient scheduling, and EMR systems
• Demonstrated independent decision-making and problem-solving ability
• Ability to prioritize tasks, adapt to changing patient and provider needs throughout the day, and stay organized while supporting a multi-specialty medical group involved in multiple Value-Based Care Contracts.
• Excellent verbal and written communication skills

Qualifications

Qualifications:

• Active Certification: CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) through AAPC or equivalent organization.
• High-school Diploma or GED equivalent required

Experience:

• 3-5 years of clinical coding experience
• 1+ year of dedicated risk adjustment coding and provider documentation experience
• Extensive experience with CMS-HCC models and ICD-10-CM coding

Benefits

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.