Risk Adjustment HCC Auditor

Product United States


Description

 

POSITION DESCRIPTION

Consultant Risk Adjustment HCC Auditor (Remote)

Talix, Inc.

 

JOB DESCRIPTION

Do you want to be a part of a Company that improves patient care? If so, Talix is the place!

Help change the way healthcare works by joining Talix’s team as a consultant.  Work alongside top subject matter experts to enhance our healthcare big data platform and core technologies.

Talix Inc., is a healthcare technology and services company powered by NLP. Our tailored solutions enable health plans and providers to manage variable revenue projects, through our custom-built workflows within our platform.  We offer Risk Adjustment coding services along with NLP technology that improves coding accuracy.

We are looking for an experienced Consultant to work as a Risk Adjustment HCC Auditor to join our team as we build a scalable and high performance healthcare data platform that fuels innovative workflow applications that improve patient care. The consultant will provide services to confirm accurate code abstraction using the Official Coding Guidelines for ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and internal procedures. The consultant will be involved with activities of code abstraction for the following programs; including but not limited to, Commercial Risk Adjustment, Medicare Advantage Risk Adjustment and Medicaid Risk Adjustment.  The auditor may also be involved in the governmental audits associated to the three programs listed above.  The consultant will be required to maintain minimum 95% accuracy on coding quality audits. This is a temporary 6 month assignment with 100% REMOTE work from home position. Potential possibility to extend the consultanting contract as the business need is made available.

PRIMARY RESPONSIBILITIES:

  • Perform/validate code abstraction and/or conduct coding quality audits of medical records to see if the ICD-10-CM codes are accurately assigned and supported by clinical documentation
  • Assist coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes
  • Review & understand customer coding guidelines
  • Conduct training and education related to audit outcomes

 

 

  • Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations
  • Maintain a minimum 95% accuracy on coding quality audits
  • Meet minimum productivity requirements as outlined by the project terms
  • Handle other related duties as required or assigned by the manager
  • Understands and agrees to role-specific information security access and responsibilities
  • Ensures safety and confidentiality of data and systems by adhering to the organizations information security policies
  • Reads, understands and agrees to security policies and complete all annual security and compliance training

QUALIFICATIONS:

The ideal candidate:

  • Must be a Certified Coder with a minimum of 3-5 years of HCC coding & auditing experience.
  • Preferably have a valid a CPC (AAPC) or CCS (AHIMA) with CRC, CDEO, CPMA, CDIP, CDI or RHIA/RHIT with coding certification
  • Must have Code abstraction and/or coding quality audits of medical records: 3-5 years (required)
  • Having an Inpatient /Outpatient CDI experience is a plus
  • Must have experience using Excel functions to develop reports, etc. (i.e., pivot tables, etc.)
  • Must have:
    • Claims experience: 2-3 years (required)
    • Must know the requirements of a CMS-1500/UB04
    • Must possess strong written and verbal communication skills
    • Must have  ICD-10-CM coding manuals, high-speed and reliable internet