Coding Auditor

6 days ago


San Diego, California, United States Sharp HealthCare Full time
Job Summary

We are seeking a skilled Coding Auditor to join our team at Sharp HealthCare. As a Coding Auditor, you will play a critical role in ensuring the accuracy and compliance of our coding practices, with a focus on risk adjustment and medical compliance.

Key Responsibilities
  • Provide administrative and coding support to management, site support, staff, and physician offices.
  • Identify and report documentation and coding opportunities, making recommendations for improved code capture and reporting.
  • Monitor and report coding trends, immediately communicating coding discrepancies to management.
  • Work to improve overall provider accuracy.
Requirements
  • H.S. Diploma or Equivalent
  • 3 Years experience working as a certified coder
  • 2 Years experience working as a HCC risk adjustment coding auditor
  • Experience with medical billing and medical terminology
  • Certified Professional Coder (CPC) - AAPC - REQUIRED
Essential Functions
  • Act as a resource, requesting, reviewing, and coding medical services from reports and notes to convert procedural and diagnostic notes into appropriate levels of care following coding rules and regulations.
  • Apply understanding of Medicare, Medi-Cal, and other payor guidelines.
  • Identify documentation deficiencies and recommend methods for resolution that satisfy regulatory and SCMG compliance requirements.
  • Perform medical chart audits meeting minimum department productivity standards.
  • Exercise mature judgment and maintain confidentiality in all activities.
  • Educate clinicians on specific coding issues based on medical records review and coding principles.
  • Educate clinicians and their staff on the HCC/Risk Adjustment coding guidelines and make recommendations for documentation improvement.
  • Educate clinicians on coding updates and processes.
  • Serve as a key resource for documentation requirements and training on the documentation requirements needed for each HCC/RAF recorded.
  • Develop and build relationships with clinicians and their staff to achieve improvements in risk adjustment documentation, data validations, as well as program participation.
Knowledge, Skills, and Abilities
  • Familiarity with radiology and laboratory coding.
  • Knowledge of Coding Procedures and Medical Terminology.
  • Proficient on CPT, HCPCS, and diagnosis coding in an ambulatory setting.
About Sharp HealthCare

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.


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