Senior HCC Coding QA Auditor

bcbsaz; United States; Hybrid; USD 70,000 - 100,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a Quality Assurance Coder/Auditor to develop risk mitigation and provider education programs. On a regular basis, you will educate primary care providers and their staff on diagnoses trends, proper documentation, and at-risk code identification with QA support.

The role requires 5+ years of professional coding with at least 3 years in HCC coding and 2 years in HCC auditing, plus CCS-P, CRC, CPC, or COC credentials.

Qualifications

• 5 years of professional coding experience, with at least 3 years of HCC coding experience, and 2 years of HCC auditing experience.
• Advanced knowledge of coding guidelines
• High School Diploma or GED

Responsibilities

• Demonstrate comprehensive understanding of HCC Coding rules, regulations, methodology and the role of hierarchies
• Review medical records and supporting documentation, determine completeness and accuracy of medical records and supporting documentation, identify and eliminate barriers to correct coding, and recommend best coding practices and improvements
• Determine valid encounters, including face-to-face, legibility and valid signature, according to Medicare Managed Care requirements
• Perform QA audits on vendor and provider group supplemental data submissions. Provide corrective action recommendations when accuracy scores fall below 95%
• Track QA audits and send out monthly updates to Vendor and management team.

Skills

HCC coding

HCC auditing

Coding guidelines

Education

High School Diploma or GED

Job description

Blue Cross Blue Shield of Arizona is seeking a Quality Assurance Coder/Auditor to develop risk mitigation and provider education programs. On a regular basis, you will educate primary care providers and their staff on diagnoses trends, proper documentation, and at-risk code identification with QA support.

The role requires 5+ years of professional coding with at least 3 years in HCC coding and 2 years in HCC auditing, plus CCS-P, CRC, CPC, or COC credentials.