HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA *Remote*

$72,717 - $115,107/Yr

Providence - Renton, WA

Full-time - Mid Level

Renton, WA

10,001+ employees

Hospitals

About the position

The HCC Risk Adjustment QA Auditor at Providence Health Plan is responsible for conducting internal coding audits related to hierarchical condition category (HCC) coding. This role ensures compliance with national coding guidelines and Providence's coding policies, while also partnering with the coding team to enhance the accuracy and quality of coding practices. The auditor will identify coding issues, provide education based on audit findings, and perform various reviews as assigned.

Responsibilities

• Perform internal coding audits of HCC coding for Risk Adjustment staff, contractors, and vendors.
• Ensure compliance with national coding guidelines and industry regulations.
• Review appropriate ICD-10-CM code assignments on risk adjustment projects.
• Collaborate with the coding team, Supervisors, and Director to improve coding practices.
• Identify coding issues and report them to Supervisor or Director.
• Provide coder-specific education based on audit findings and trends.
• Conduct HCC abstract reviews, chart reviews, and other assigned reviews.

Requirements

• 5+ years of 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.

Nice-to-haves

• Bachelor's Degree -OR- a combination of equivalent education and experience.
• Active Certification: CRC.

Benefits

• 401(k) Savings Plan with employer matching
• Health care benefits (medical, dental, vision)
• Life insurance
• Disability insurance
• Paid parental leave
• Vacation and holiday time off
• Voluntary benefits
• Well-being resources