Summit Health

Top Health.

  • Remote, OR


  • Irreversible.

  • Full-time.

Job Description

Oregon State candidates chosen. Out of state prospects thought about.

  • Coding Compliance HCC Auditor– Chart Reviews
  • Reviews medical record for correct task of medical diagnoses according to AMA, AHA, ICD-10- CM Guidelines.
  • Ensure medical diagnosis reporting satisfies all AMA, ICD-10- CM, HCC, Risk Adjustment Reporting, and CMS Guidelines
  • Utilizes a risk-based audit technique and develops initial scope of evaluations, includes patterns and trending analysis based upon carrying out evaluation and notifying the Manager and/or Director of any locations of recognized issue
  • Proficiently makes use of readily available software application day-to-day to achieve both Core and Job Specific Duties and Responsibilities. (e.g. Payer Reports Excel, Word, Encoder Pro, numerous EHR’s, Microsoft Outlook, different Payer reports, HCC tools both from Payers and internal developed top priority information bases)
  • Provides education to Physicians and other personnel on suitable documents requires as it associates with suitable HCC code capture.
  • Maintains top-level of specialized particular coding and auditing standards as it associates with HCC principles.
  • Utilizes logs to determine and interact patterns and patterns discovered in Audit Reviews
  • Understands and carries out the MEAT principle
  • Recognizes and reports issues, mistakes and inconsistencies in medical records
  • Review of doctor reports (payment reports, UPIP, and so on) for locations of required HCC education or prospective coding improvement.
  • Prepares composed reports findings to provide to Manager, Physicians or other celebrations
  • Assist Management with unique HCC jobs as appointed
  • Demonstrates the capability to handle several jobs
  • Ability to work different payor HCC payor space reports
  • Ability to work information to develop internal space report and HCC Provider focused lists
  • Meets performance requirements and turn-around times.
  • Anticipates and carries out essential responsibilities.
  • Coding Compliance Educational Efforts
  • Conducts audit evaluations connected to Coding Compliance efforts and communicates/collaborates with Coding Compliance Management and other groups concerning audit results and instructional locations of chance
  • Research and offer polite, precise and prompt reaction to queries from doctors associating with HCC Risk Adjustment tasks and reports
  • Provide comprehensive comments/feedback on doctor efficiency based upon both potential and retrospective chart evaluation (e-mail interaction, conferences, discussion, and so on)
  • Meet with management and help in producing specific company education prepares customized to service provider’s particular requirements based upon evaluation findings
  • Serve as resource for internal and external clients to acquire info or explanation on precise and ethical coding and documents requirements, standards and regulative requirements.

General Job operates:

The Coding Compliance HCC Auditor should display an understanding of coding principles, AMA, CMS/OIG/Federal/ State policies and standards, in addition to HCC and other threat change reporting steps. Furthermore, should show the capability to use an analytical approach and scope technique for coding/documentation evaluation and threat analysis.

Must display efficiency in using HCC and ICD-10 auditing principles are needed in order to carry out official chart evaluations. The Auditor is accountable for both internal (arranged, focused & job driven) and external audits for the functions of keeping an eye on compliance to last resolution. Official recorded results, tracking of patterns, putting together of evaluation reports and academic interaction to Managers and/or Providers with audit findings are needed. Coding Compliance HCC Auditor is likewise anticipated to keep up with HCC reporting, specialized particular coding, auditing and compliance advances.

Physical Job Requirements:

  • Ability to multi-task, arrange & focus on work within any provided setting
  • Endurance to work long hours on jobs
  • Ability to process a big quantity and unique kinds of information
  • Ability to operate in restricted and/or different workstations
  • Ability to deal with varied characters

Education, Certification, Computer and Training Requirements:

  • Associate Degree minimum/ Bachelor Degree chosen
  • Work associated experience: 2 years minimum
  • Auditing experience: 1 year minimum favored
  • Previous monitoring experience: chosen
  • Proficient usage of Microsoft Office Applications (Excel, Word, PowerPoint)
  • Medical Coding Certificate– Required
  • Coding Certification – CRC, CPC, CCS-P, CCA, RHIT or RHIA- Required
  • Auditing, Compliance and Billing or Practice Management Certifications– CEMC, CPCO, CPMA, CCP-P, CHC, CPPM, and so on– Preferred
  • Clinical and/or Population Health experience (e.g. registered nurse, LPN, CNS) taken into account in lieu of coding accreditation (should acquire accreditation within 1 year)

Travel

  • Travel utilizing individual automobile is needed to different areas (more than 1 mile).
  • National travel might be needed.

Benefits *

A friendly and busy environment dealing with enthusiastic individuals

Outstanding development chances

Time Off

Medical, Dental and Vision Insurance

Short/Long Term Disability, HSA, and Life Insurance

401 K strategy with business matching contribution

Cash Bonus Programs

Recognition and benefits programs to acknowledge effective groups

Other Perks & Discounts

Commuter and parking discount rate program to assist you conserve (utilizing pretax dollars)

Full Time Benefit Eligible Employees Only

Equal Opportunity Employer

Our Company offers equivalent job opportunity (EEO) to all staff members and candidates for work without regard to, and does not discriminate on the basis of, race, color, religious beliefs, creed, gender/sex, sexual preference, gender identity and expression (consisting of transgender status), nationwide origin, origins, citizenship status, age, special needs, hereditary details, marital status, pregnancy, military status, veteran status, or any other particular safeguarded by appropriate federal, state, and regional laws.

Safety Disclaimer

Our Company appreciates the security of our staff members and candidates. Our Company does not utilize chatroom for task searches or interactions. Our Company will never ever ask for individual details by means of casual chat platforms or unsecure e-mail. Our Company will never ever request cash or an exchange of cash, banking or other individual details prior to the in-person interview. Know possible rip-offs while task looking for. Interviews are carried out at choose Our Company areas throughout routine company hours just. For details on task frauds, go to, or submit a grievance at.

Top Health.

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