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HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA

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Providence

12d ago

  • Job
    Full-time
    Senior Level
  • Legal
    Healthcare
  • Oregon

AI generated summary

  • You need 5+ years HCC coding, 3+ years auditing, proficiency in Excel/Word/EMR, and active certification (RHIT, RHIA, CCS, or CPC).
  • You will conduct internal audits of HCC coding, ensure compliance with coding standards, review ICD-10-CM assignments, partner with the coding team for improvements, identify issues, and provide education.

Requirements

  • 5+ years HCC specific coding experience
  • 3+ years of recent auditing experience
  • Proficiency in Microsoft Excel, Word, and various EMR systems
  • Active Certification in one or more of the following: RHIT, RHIA, CCS, or CPC

Responsibilities

  • Perform internal coding audits of hierarchical condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors
  • Perform audits to ensure compliance with national coding guidelines and industry regulations, as well as adherence to Providence Health Plan's coding policies
  • Review appropriate ICD-10-CM code assignments on risk adjustment retrospective and prospective projects
  • Partner with the coding team, Supervisors, and Director to improve the accuracy, integrity, and quality of coding practices as well as to ensure minimal variation in coding practices
  • Identify coding issues and report issues to Supervisor or Director
  • Provide coder specific education based on audit findings and trends
  • Perform HCC abstract reviews, chart reviews, and other reviews as assigned

FAQs

What is the role of the HCC Risk Adjustment QA Auditor at Providence Health Plan?

The HCC Risk Adjustment QA Auditor performs internal coding audits of hierarchical condition category (HCC) coding, ensuring compliance with coding guidelines and regulations, and providing education based on audit findings.

What are the required qualifications for this position?

The required qualifications include 5+ years of HCC specific coding experience, 3+ years of recent auditing experience, proficiency in Microsoft Excel, Word, various EMR systems, and an active certification in one or more of the following: RHIT, RHIA, CCS, or CPC.

Is a Bachelor's degree required for the HCC Risk Adjustment QA Auditor position?

A Bachelor's degree is preferred but not required. A combination of equivalent education and experience is acceptable.

Where is this position located?

This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon.

What does the benefits package include?

The benefits package includes health care benefits, a retirement 401(k) savings plan with employer matching, life insurance, disability insurance, paid time off, and various voluntary benefits.

Who can apply for this position?

Applicants who reside in Oregon and Washington are welcome to apply for the HCC Risk Adjustment QA Auditor position.

What is the pay range for this position?

The pay range for the HCC Risk Adjustment QA Auditor position is $34.96 to $55.34, with potential additional compensation opportunities available.

What will be the primary focus of the HCC Risk Adjustment QA Auditor?

The primary focus will be on performing internal coding audits, reviewing ICD-10-CM code assignments, identifying coding issues, and providing education to coding staff based on audit findings.

What type of work environment does Providence Health Plan promote?

Providence Health Plan fosters a culture of patient-focused, whole-person care, emphasizing mutual respect, empowerment, and diversity within the workplace.

What is the role of Providence Shared Services in relation to this position?

Providence Shared Services provides a variety of functional and system support services across the Providence family of organizations, supporting the mission of delivering quality care.

Science & Healthcare
Industry
10,001+
Employees
1856
Founded Year

Mission & Purpose

Every day, 119,000 compassionate caregivers serve patients and communities through Providence St. Joseph Health, a national, Catholic, not-for-profit health system, driven by a belief that health is a human right. Rooted in the founding missions of the Sisters of Providence and the Sisters of St. Joseph of Orange, courageous women ahead of their time who brought health care and other social services to the American West when it was still a rugged, untamed frontier, we share a singular commitment to improve the health of all. From our earliest days, we’ve met new challenges by pioneering new solutions. Today, with 51 hospitals, 829 clinics and a comprehensive range of services, we strive to meet the needs of communities across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington through a diverse family of Catholic, other faith-based and mission-driven secular organizations. Now, as we face a new frontier—a changing health care landscape—we draw upon their pioneering and compassionate spirit to plan for the next century of health for a better world, especially for the poor and vulnerable.

Culture & Values

  • Compassion

    We reach out to those in need and offer comfort as Jesus did. We nurture the spiritual, emotional and physical well-being of one another and those we serve. Through our healing presence, we accompany those who suffer.

  • Dignity

    We value, encourage and celebrate the gifts in one another. We respect the inherent dignity and worth of every individual. We recognize each interaction as a sacred encounter.

  • Justice

    We foster a culture that promotes unity and reconciliation. We strive to care wisely for our people, our resources and our earth. We stand in solidarity with the most vulnerable, working to remove the causes of oppression and promoting justice for all.

  • Excellence

    We set the highest standards for ourselves and our ministries. Through transformation and innovation, we strive to improve the health and quality of life in our communities. We commit to compassionate, safe and reliable practices for the care of all.

  • Integrity

    We hold ourselves accountable to do the right things for the right reasons. We speak the truth with courage and respect. We pursue authenticity with humility and simplicity.