RISK ADJUSTMENT CODING AUDITOR II

Risk Adjustment Coding Auditor II

Galen Medical Group offers several medical specialties throughout the Chattanooga region. We provide quality care and patient-friendly services to adults and children of all ages. 

Our mission is to elevate the health of our community through multiple medical specialties providing excellent care delivered with wisdom, compassion, integrity, and a commitment to technology, education, and scientific inquiry. Galen is CHATTANOOGA'S Doctor! 

Summary/Objective:

The Risk Adjustment Coding Auditor II is responsible for reviewing and analyzing patient medical records to ensure accurate coding and documentation of chronic conditions based on ICD-10-CM guidelines and CMS standards. This role supports accurate health status assessment to drive appropriate reimbursement and quality care. This position will interact with physicians, coding staff and other members of the health care team to ensure the accuracy and completeness of clinical documentation to support resource utilization and patient outcomes. 

Essential Functions:

• Medical Record Review: Thoroughly analyze outpatient/inpatient medical records to identify chronic conditions, co-morbidities, and relevant diagnostic information.

• Accurate Code Assignment: Assign accurate ICD-10-CM codes, ensuring all relevant HCCs are captured according to the MEAT criteria (Monitoring, Evaluation, Assessment, Treatment).

• Documentation Improvement: Identify documentation gaps and provide actionable feedback to clinicians to enhance documentation specificity and completeness.

• Compliance Monitoring: Comply with HIPAA regulation, CMS regulations, and internal policies to ensure accuracy and reduce risk during audit inquiries.

• Data Accuracy: Ensure all assigned codes are supported by clinical evidence in the documentation and maintain high productivity and quality standards.

• Collaboration: Communicates with providers regarding coding best practices and documentation requirements.

Other Duties/Responsibilities:

• Protects self and other team members by following all compliance, HIPAA, and infection prevention guidelines and regulations.
• Respects patients by recognizing their rights; maintaining confidentiality.
• Maximize the use of resources to improve quality outcomes with the reduction of unnecessary tests/procedures, maintaining accurate and complete documentation in the medical record.
• May provide telephonic outreach to patients identified as high risk, with chronic condition(s) to assist with medical record requests, as needed.
• Thorough understanding of ICD-10, CPT, and complex co-morbidity coding.
• Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices, and participating in professional organizations regarding clinical quality measures and governmental regulations.
• Other duties as assigned.

Knowledge/Skills/Abilities:

• Strong interpersonal skills.

• Strong understanding of ICD-10-CM coding, medical terminology, and CMS-HCC models.

• Basic understanding of medical office workflows, patient scheduling, and EMR systems

• Demonstrated independent decision-making and problem-solving ability

• Ability to prioritize tasks, adapt to changing patient and provider needs throughout the day, and stay organized while supporting a multi-specialty medical group involved in multiple Value-Based Care Contracts.

• Excellent verbal and written communication skills

Qualifications:

Education:

• Active Certification: CRC (Certified Risk Adjustment Coder) and CPC (Certified Professional Coder) through AAPC or equivalent organization.
• High-school Diploma or GED equivalent required

Experience:

• 3-5 years of clinical coding experience
• 1+ year of dedicated risk adjustment coding and provider documentation experience
• Extensive experience with CMS-HCC models and ICD-10-CM coding

Please note that this job description is not intended to cover or list in full the activities, duties, or responsibilities required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

As part of the Galen Medical Group, the applicant must be a team player and provide excellent customer service while assessing our patients needs efficiently. Perform all duties in compliance with Galen Medical policies, HIPAA, and OSHA standards.

Galen Medical Group is a member of the TN Drug-Free Workplace and it is a requirement that we conduct a pre-employment drug screen, as part of the hiring process.

Why should you apply?

• 401(k) benefits.
• Education reimbursement.
• Holiday Pay.
• Great earned time-off policy.
• Company-paid Life Insurance & Long Term Disability.