What are the responsibilities and job description for the HCC Auditor/Coder position at Peyton Resource Group?
Job Title : HCC Auditor
Reports to : Director ACI / Coding
Job Purpose
Under the direction of the management team, the HCC Auditor is responsible for performing concurrent, prospective, and retrospective chart reviews and data validation to improve the department’s RAF score goals and maximize revenue. This position ensures the accuracy of HCC codes captured in the encounter data submission by reviewing and validating electronic medical charts against provider documentation.
The HCC Auditor will also perform physician queries for coding and documentation clarification during the prospective chart review process. The incumbent will assist in identifying and assessing coding opportunities and areas requiring provider educational outreach. Additionally, this role supports the management team in selecting the best medical records for Health Plan chart review audits and / or CMS RADV audits.
Essential Job Duties & Responsibilities
- Conduct prospective and retrospective chart review audits on outpatient medical records to ensure the accuracy and completeness of documentation supporting HCC coding per ICD-10 CM guidelines.
- Review medical records to identify and validate HCC coding accuracy, abstracting data as necessary when not captured in claim submissions during CMS sweep periods.
- Assist in concurrent chart review processes and perform physician queries for coding and documentation clarification in accordance with established policies.
- Maintain a tracking and management tool for assigned medical record review projects.
- Meet and maintain productivity and quality metrics as defined by QA policy.
- Participate in Health Plan RACCR audits and CMS Risk Adjustment Data Validation (RADV) audits as needed.
- Assist management in selecting "best medical records" to validate and support HCC codes.
- Provide post-chart review audit reports as needed.
- Stay up to date with state and federal regulations, as well as ICD-10-CM coding guidelines.
- Attend coding and documentation webinars (e.G., Optum, AHIMA, AAPC) on a regular basis.
- Follow HIPAA protocols and comply with state and federal regulations.
- Perform additional duties or projects as assigned by management.
Experience
Education
Certified Professional Coder ( CPC )
Knowledge, Skills & Abilities
Work Hours & Travel Requirements
Working Conditions & Physical Requirements
Business Requirements
