HCC Auditor

Healthcare IT Recruiter | Provisions Group

HCC Auditor

Hybrid. 2/3 days per week on site in San Antonio

US Citizens only

Under the direction of the management team, the HCC Auditor is responsible for performing concurrent, prospective and retrospective chart reviews and data validation in effort to improve department’s RAF score goals and maximize revenue. This position is responsible for reviewing and validating electronic based medical charts to ensure the accuracy of the HCC codes captured in the encounter data submission is supported by the provider documentation.

The HCC auditor will also perform physician queries for coding and documentation clarification during the prospective chart review process. The incumbent will assist in identifying and assessing coding opportunities, and areas needed for provider educational outreach activity. The incumbent will also support the management team in selecting the best medical records for Health Plan (s) chart review audits and/or CMS RADV audits.

This position is reported to the Director of Risk Adjustment/HCC coding.

We believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission “to deliver quality and compassionate care with outstanding service, every patient, every time”. As a HCC Auditor we expect you to embody and promote our Values and defined behavioral expectations.

• Integrity: Do the right thing, the right way, every time. Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.
• Compassion: Treat everyone with respect and dignity. Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.
• Synergy: Collaborate to improve outcomes. Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself and your work
• Stewardship: Use resources responsibly and efficiently. Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.
• Conduct both prospective and retrospective chart review audits on outpatient medical chart notes to ensure the accuracy and completeness of documentation that reflects accurate coding selection per ICD‑10‑CM guidelines/reporting, which substantiates HCC codes captured and submitted to CMS for reimbursement.
• Review medical record information to identify and assess accurate coding based on CMS‑HCC categories and abstract HCC data from provider chart notes if not captured or submitted via encounter/claim data submission during CMS sweep periods.
• Assist with the concurrent chart review process and perform physician queries for coding and documentation clarification following physician query policy and procedure standards.
• Maintain a tracking and management tool for assigned medical record review projects.
• Meet and maintain productivity and quality metrics as defined and required by QA policy.
• Participate in Health Plan’s RACCR audits, CMS Risk Adjustment Data Validation (RADV) audits as needed.
• Assist the management team in selecting “best medical records” that validate and support HCC codes.
• When necessary assists the Director of HCC coding with post‑chart review audit finding reports.
• Stay abreast with state, federal rules, regulations, and ICD‑CM coding guidelines.
• Attend Optum coding/documentation webinars and or other coding source learning opportunity webinars on a monthly basis such as AHIMA, AAPC, etc.
• Follow HIPAA protocol and comply with state and federal regulations.
• Additional duties or project may be assigned by management team as needed.

• Must possess a minimum of 3 years of coding experience and at least 1 year of HCC/risk adjustment coding experience required with emphasis in the managed care environment or healthcare plan.
• Up to 1+ years of auditing experience and extensive…