Coding Specialist - Auditor

Washington Regional Medical Center Fayetteville , AR 72701

Posted 3 months ago

Washington Regional

Washington Regional Medical Center is our region's only locally governed, community-owned, not-for-profit healthcare system. Our system includes a 425-bed acute care hospital located in the heart of Fayetteville supported by our clinic system - including primary, specialty and urgent care operations - that span across Northwest Arkansas into Harrison and Eureka Springs. Being heavily supported and invested in our community makes Washington Regional a unique employer, encouraging staff to give back to the community in which we live and work and give back to each other.

Washington Regional Mission, Vision and Values prove to be a firm foundation and inspiration from which we fulfill our purpose.

Mission: Washington Regional is committed to improving the health of people in communities we serve through compassionate, high quality care, prevention and wellness education.

Vision: To be the leading healthcare system in Northwest Arkansas --- the best place to receive care and the best place to give care.

Values: To treat others - patients and their families, visitors, physicians, and each other - as we would want to be treated.

SUMMARY

The role of the Medical Risk Adjustment and Compliance Analyst reports to the Manager of Profee Coding and Practice Transformation Dept. This position is responsible for chart reviews of medical records for outpatient/inpatient providers. Provides timely identification of deficiencies and educational needs to provider(s) and coder(s). Reports clear and detailed recommendations to improve documentation of E/M services, CPT, specificity of ICD10 codes and RAF scores. The position is responsible for management, implementation and delivery of assigned audit phases, including planning, fieldwork, and reporting of HCC Risk Adjustment, Ambulatory Care Programs, Healthcare Effectiveness Data and Information Set (HEDIS) and other reporting. This position will spend 90+% of the time sitting.

Responsibilities

  • Conduct focused risk adjustment and compliance reviews on providers and clinics, as directed by management, tracking results and identifying trends and deficiencies for follow up training for providers and/or coders.

  • Support coders by performing quality assurance reviews and providing appropriate education.

  • Create educational material and present training to providers and coders, as needed.

  • Independently, or as directed, research complex coding HCC issues and keep abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA, Federal Register and third-party contracts.

  • Participation in PTT and other provider meetings as needed.

  • Protect data integrity and validity.

Qualifications

  • Education: Associate's degree in related field or equivalent experience

  • Licensure and Certifications: CPC, CRC or other comparable coding credentials

  • Experience: 3-5 years of auditing experience. Thorough understanding of Risk Adjustment, HCCS coding, ICD coding, HEDIS, and CPT coding. Excellent communication, presentation and analytical skills.

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Coding Specialist - Auditor

Washington Regional Medical Center