QHP Auditor (AHA)

Responsibilities:

• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation.
• Primarily for QHP (RADV).
• Ability to code government and state models.
• This includes code everything projects.
• Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations.
• Ability to maintain a 95% accuracy rate on all coding projects.
• Coders assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures.

Required Certifications:

• Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.).
• The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
• CPC Certification.

Required Skills & Experience:

• Strong organizational skills.
• Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel, and Outlook.
• Strong written and verbal communication skills.
• Ability to work independently in a remote environment.
• Private lockable office space to ensure security of Member PHI.
• Minimum of 7 years coding experience with at least 5 of those years in Risk Adjustment coding.
• Completion of an accredited medical coding program with current unencumbered credentials.
• RADV Experience Mandatory.
• Risk Adjustment coding: 5 years.
• Coding: 7 years.

Supervision Received:

• General supervision is received weekly.

Interview Requirements:

• Candidates must have encoder or coding book for interview, skill assessment will be included on interview.