CTX Remote/Travel Provider Educator / Risk Adjustment Auditor II

    • Costa Mesa, CA

IND 004-007

Title: Remote/Travel Provider Educator

Where: Onsite in Austin, TX

Type: Contract to Hire

Hours: Monday - Friday Day time hours

Qualifications:

The HCC Auditor will do a review of medical records to determine the completeness and accuracy of HCC coding by ensuring that the assigned codes and HCC codes are supported by clinical documentation.

Reviews medical records to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure. Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.

Reviews patient records for accuracy in HCC ICD-10-CM coding. Ask the Candidates to provide a couple of errors they find when performing these audits.

Provide education and training to physicians, and appropriate office staff on correct coding protocol and guidelines---Ask the candidate to tell you about an educational or training session they presented to the Physicians and/or staff.

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