HCC (Coder) Risk Adjustment Specialist Job in Santa Ana 92705, California US

Prospect Medical is searching for a qualified:

HCC (Coder) Risk Adjustment Specialist
In Santa Ana/Ontario areas
Must be AHIMA or AAPC Certified


SUMMARY

. The HCC Risk Adjustment Specialist will perform various audits as assigned by management to ensure physician documentation compliance. The Risk Adjustment Specialist may generate HCFA-1500 claim forms for diagnosis codes found in progress note documentation during an audit. The Risk Adjustment Specialist will perform provider training sessions as requested by management. The HCC Risk Adjustment Specialist is responsible for training new staff members as requested by management, as well as, being a resource for other team members and management.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES

 

The following are included but not limited to:

·         Abstract pertinent information from assigned medical records using ICD-9-CM, CPT and/or HCPCS codes.

·         Provide management with input on provider performance from assigned audits and special projects

·         Document all chart audit findings in IDX system and applicable audit tools on a daily basis

·         Ensure audit tools contain adequate evidence to support audit findings and reviews audit tools for accuracy and completeness.

·         Ensure all captured diagnoses is properly documented and supported within progress note according to CMS rules and regulations including but not limited to encounter date, legibility, proper provider signature and member identification requirements.

·         Report noncompliance issues detected through auditing.

·         Adheres to Official Coding Guidelines.

·         Research and provide courteous, accurate and timely response to inquires by providers as related to HCC Risk Adjustment projects and reports.

·         Responsible to forward HCC Claims generated to the HCC Risk Adjustment Analyst on the same day for claim processing.

·         Submit bi-weekly and monthly requested workflow reports

·         Assist with reconciliation of invalid diagnosis list supplied by Claims Department

·         Timely generates and forwards HCC Claims for processing to the HCC Risk Adjustment Analyst

·         Serve as a resource for internal and external customers to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines and regulatory requirements

·         Provide one on one provider training and audit sessions as requested by management

·         Attendance of additional provider training sessions based on departmental needs

·         Provide support to the HCC Risk Adjustment program with the goal to increase the overall Risk Scores of all IPA’s

·         Assist with chart retrieval from provider office based on departmental needs. May include some travel with personal vehicle

·         Perform various audits and special projects as assigned by management

 

EDUCATION and/or EXPERIENCE

 

·         A High School Diploma or Equivalent; BS/BA preferred

·         Must possess and maintain an AAPC or AHIMA certification – CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, RHIA

·         2 – 5 years experience in healthcare setting preferably related to HCC Risk Adjustment and/or chart auditing

·         Working knowledge of CMS HCC Risk Adjustment methodology

·         Knowledge of IDX preferred but not required

·         Maintains member confidence and protects operations by keeping claim information confidential in compliance with HIPPA requirements.

 

Prospect Medical has a solid past and a dynamic future.  Over 20 years old, we have grown and matured---we are now a publicly-traded IPA and medical management services company.  We contract with all major regional HMO’s including PacifiCare, Blue Cross, Health Net and CIGNA.  We are now serving California’s seniors with a superior Medicare program, and we are pursuing additional growth through a strategy of targeted acquisition.  We succeed through the use of superior technology, proven management procedures, and committed employees. Our success allows us to offer excellent compensation and one of the best benefit packages in the industry.

If you are a qualified, high-achieving professional who wants to make a positive difference in the world of managed care, please submit your resume online.  

Quality Service, Quality Care…that’s who we are!

Please visit our website for more information and a listing of all our open positions
www.prospectmedical.com