HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA

at  Providence Health Plan

PROVIDENCE HEALTH PLAN CAREGIVERS ARE NOT SIMPLY VALUED – THEY’RE INVALUABLE. JOIN OUR TEAM AND THRIVE IN OUR CULTURE OF PATIENT-FOCUSED, WHOLE-PERSON CARE BUILT ON UNDERSTANDING, COMMITMENT, AND MUTUAL RESPECT. YOUR VOICE MATTERS HERE, BECAUSE WE KNOW THAT TO INSPIRE AND RETAIN THE BEST PEOPLE, WE MUST EMPOWER THEM.

Providence Health Plan is calling an HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA who will:

• Perform internal coding audits of Hhierarchical 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

REQUIRED QUALIFICATIONS FOR THIS POSITION INCLUDE:

• 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

PREFERRED QUALIFICATIONS FOR THIS POSITION INCLUDE:

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

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