Coding Auditor na AllCare Health

Coding Auditor at AllCare Health with the Quality department in Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.

Job Duties

• Data analysis is performed to generate reporting packages that serve both internal purposes and external risk adjustment requirements. 
• Chart data are meticulously reviewed to ensure accurate Hierarchical Condition Category (HCC) coding, accompanied by informed recommendations for providers. 
• Reviews medical records as needed (MRR, OR1, any backlog) and assist platform clients as needed with backlog and larger chart page counts.
• Work que is addressed with goal to clear within 72 hours.
• Updates and maintains training course material for medical record abstraction and data entry (HEDIS, RISK, IVA).
• Maintains an accuracy score of 95% on all work submitted (all projects).
• Works actively to monitor and maintain minimum 95% accuracy in all coding projects by providing coaching/feedback to coders, as well as researching literature and/or attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).
• Audit reports are meticulously developed, with findings presented to providers in a clear and constructive manner. 
• Assistance is provided on complex internal audits, guided by established management directives, while adhering to auditing standards and professional practices and respecting defined schedules and deadlines. 
• Support the HEDIS Medical Chart Auditor.
• Support Compliance with medical chart audits against claims.
• Data is collected, organized, and disseminated effectively among both external and internal stakeholders, incorporating recognized best practices for process improvement. 
• Conducts and facilitates prospective, retrospective, and concurrent reviews.
• Assists in the development and presentation of corrective action plans to providers where weaknesses in control have been identified and conducts ongoing monitoring until remediation solutions are resolved.
• Collects, organizes, and shares data with external and internal stakeholders, including process improvement best practices.
• Various documents and reports are prepared as required. 
• Collaborate with the Provider Engagement team for provider outreach to enhance provider/clinic experience through best practices and utilizing analytics  
• Monitors and adheres to compliance standards, including HIPAA regulations and organizational policies.
• Stays updated on changes in coding guidelines, payer regulations, and CMS policies.
• Maintains punctual, regular and predictable attendance.    
• Works collaboratively in a team environment with a spirit of cooperation.
• Respectfully takes direction from leadership.
• Meets all required training including those listed in Relias Learning Module System (LMS).
• Performs other duties as assigned.

On Call Responsibilities 

This position does not have any on call responsibilities. 

Supervisory Responsibilities 

This position does not have any supervisory responsibilities.

Job Requirements

May require the use of a personal cell phone (cell phone stipend applicable).

Qualifications                                                                                                                                                                                                                

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage you to apply if you are bilingual.

All relevant experience can be listed in your resume to perform essential duties of the position including the following: lived, volunteer, professional, or a combination of experience and education.

Education

High school diploma or general education degree (GED) required. One-year certificate from college or technical school in CRC preferred.

Experience

Two to four years related experience in coding experience with specific knowledge of Medicare and Commercial Risk Adjustment such as Hierarchical Condition category (HCC).

Certificates, Licenses, and/or Registrations 

Certified Risk Adjustment Coder (CRC) or willing to be certified within 1 year of hire.

Technical Skills

• Proficient in facility coding (OPPS/IPPS) and RADV audits 
• Strong understanding of the healthcare industry and HIPAA compliance 
• Skilled in Microsoft Office Suite and learning management systems 
• Knowledgeable in operating systems, programming languages, and software technologies 
• Experienced in data interpretation, pay equity assessments, and compensation analysis
• Exceptional writing, editing, and proofreading skills 
• Professional and empathetic communication with diverse teams and customers 
• Skilled in conflict resolution, negotiation, and building trust 
• Able to collaborate effectively in multidisciplinary and multicultural environments

Interpersonal Skills

• Highly organized with strong time management and prioritization abilities
• Capable of synthesizing information from multiple sources to solve problems
• Demonstrates initiative, sound judgment, and decision-making independence
• Adapts quickly to change and ambiguity with creativity and resourcefulness
• Maintains confidentiality, professionalism, and cultural awareness
• Manages stress effectively and self-regulates in challenging situations
• Provides respectful service to individuals with mental illness and diverse backgrounds
• Committed to continuous learning and behavioral growth

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.   Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Computer Skills

Job requires specialized computer skills.   Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.  

Reasoning Ability

Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands & Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.

• The employee must be able to work onsite, as needed.
• The employee must be able to work from a home office, as needed.
• Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.

Company Overview

AllCare Health Website:  https://www.allcarehealth.com.

AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp® status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)

AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.

The AllCare Health family of businesses is guided by our corporate principles:

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others. 

If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.