JOB TITLE: Coding Auditor
REPORTS TO: Director, Business Operations

POSITION SUMMARY:
The Coding Auditor provides coding audits, guidance and education as requested by ECMP for its provider base. Overall responsibility for Risk Adjustment, which includes Hierarchical Condition Coding (HCC) or other risk adjusted revenue programs to ensure complete and accurate revenue.
EDUCATION/CERTIFICATION:
• Bachelor’s degree preferred.
• CPC preferred or a mix of experience and education.
EXPERIENCE:
• Minimum of 2 years recent and related experience in medical record documentation review, diagnosis coding and auditing.
COMPETENCIES:
• ICD-10 Proficiency.
• Knowledge of HCC codes.
• Experience with Medicare and Medicaid Risk Adjustment.
• Experience with MS Office.
• Excellent communication and interpersonal skills.
• Ability to understand and convey complex information to many different kinds of people.
• Strong business, analytical and project management skills; a good understanding of revenue cycle management, health care finance and processes to include clinical workflows.
• Reliable transportation to travel to offices is an essential function of the role.

ESSENTIAL DUTIES and RESPONSIBILITIES:
Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time.

1. Build an HCC/RAF program to include-
 Data mining strategies for members covered under risk-based models.
 Develop organization-wide data collection and methodology and an effective HCC/RAF coding program.
 Standardization of HCC/RAF workflows, including monitoring and improvement of error rates and timely submission.
 Provider and Practice education and performance monitoring and improvement.
 Develop a training program for Community based providers and staff to ensure valid HCC documentation.
 Coordinate network provider and staff training required to address knowledge gaps and new HCC/diagnoses identified as opportunities.
 Make recommendations to providers/practices as to how to best support the HCC/RAF optimization strategies
 Present HCC/RAF performance results and findings regularly to physicians and practice, including overall HCC/RAF score, improvement strategies and tactics.
2. Remotely performs audits of medical records to ensure all assigned ICD10 codes are accurate and supported by written clinical documentation.
3. Reviews coding history and benchmarks to make certain there are no missed opportunities and identify risk areas.
4. Apply knowledge of CPT format guidelines and notes to locate the correct code and to sequence properly for services rendered.
5. Provides initial coding audit and education to new providers and subsequent follow up audit after 90 days. Further follow up with providers as necessary.
6. Effectively communicates the audit process and results to the appropriate departments and management.
7. Provides training and education to providers in order to improve documentation and coding practices.
8. Remains current on ICD 10 codes, CMS documentation requirements and State and Federal regulations.