The HCC Auditor will do a review of medical records to determine the completeness and accuracy of HCC coding by ensuring that the assigned codes and HCC codes are supported by clinical documentation.
Reviews medical records to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives. Performs physician queries as needed in order to validate ICD-10 diagnosis codes and follows established physician query policy and procedure. Ensures the diagnosis codes for each chronic or major medical condition have been captured and submitted within the permitted CMS timeframe.
– Provide education and training to physicians, and appropriate office staff on correct coding protocol and guidelines
– Required: 2-5 years experience with coding validation and knowledge of Medicare HCC coding protocol
To apply for this job please visit www.addisongroup.com.