Job Description

We are looking for HCC Risk Adjustment Auditors/Coders to join our team!

The HCC Risk Adjustment/Auditor is responsible for maintaining and monitoring the Quality Assurance auditing plan for outpatient clinical data. This position works to improve the quality of coding documentation and data in the medical record and HCC database. The HCC Risk Adjustment/Auditor reports on the accuracy and consistency of the data in accordance with accepted and established standards. Risk Adjustment Auditors collaborate with the Manager to provide expertise in the use and application of coding classifications, such as ICD-9-CM and/or ICD-10-CM. Auditors also record documentation to ensure compliance in the collection of outpatient diagnoses and services.

Essential Duties and Responsibilities include the following:

• Works as an integral member of the Finance Department.
• Code review super bills and patient medical records for proper use of diagnosis and procedure codes.
• Interface effectively with physicians and office staff on coding issues. Research coding questions as needed.
• Code review a wide variety of document types, i.e., Primary and specialty care medical records, mental health, substance abuse, in-patient, out-patient, non-submittals (lab), ancillary, and pharmaceutical services for HCC values.
• Perform both provider office audits and online audits by reviewing patient medical records.
• Provide education to the provider and staff on office audit findings. Communicate best coding practices.
• Consistently meet productivity and quality standards as outlined by the supervisor.
• Generate MS Excel spreadsheets for various projects with the primary focus on tracking activities.
• Make internal and external phone calls to other departments and provider offices as needed.
• Learn software programs essential to the HCC department, such as iCode, EZCap, and Access Express. Als,o learn the HCC model.
• Upload medical records via our internal software program iCode.
• Research and correspond with our providers to obtain correct diagnosis coding as generated from internal and external error reports.
• Present educational material to providers.
• Perform photocopy services.
• Perform scanning services.
• Perform faxing services.
• All other duties as directed by management.

The pay range for this position at commencement of employment is expected to be between $25 - $27 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, the employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest-growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming, and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full-Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement:

• 4401 (k)Retirement Savings Plan
• Income Protection Insurance

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Qualifications

Education and/or Experience :

Must have these requirements under the umbrella of the HCC industry:

• Requires knowledge in HCC Coding documentation guidelines.
• Requires technical expertise in ICD-9-CM or ICD-10-CM.
• Strong skills in medical record audit and review.
• Regulatory requirements for coded data.
• Medical record documentation requirements.
• Understanding of healthcare data systems.
• Proficiency in MS Outlook and Word.
• Strong proficiency with Excel--must have ability to prepare spreadsheets.
• Excellent written and verbal communication skills.
• Certification is a plus with HCC.
• AHA coding clinic is a plus.
• Certification required in CPC and/or CCS, and CRC is a plus.

Hybrid Schedule Requirements

Part A

• Monday - Wednesday onsite / Thursday - Friday Remote

Part B

• Wednesday - Friday Onsite / Monday - Tuesday Remote