Auditor (Risk Adjustment) - Contract/1099 - IntraCare

IntraCare Health Center (DFW Healthcare MSO) proudly serves the greater Dallas-Ft. Worth and Phoenix, Arizona areas with a decade of excellence in value-based care and clinic operations. Our outstanding leadership and commitment to service have established us as a trusted partner for multiple healthcare organizations.

At IntraCare, we believe in more than just a job; we offer a vibrant workplace where culture and collaboration thrive. We are dedicated to fostering an inclusive environment that values diverse perspectives and promotes respectful dialogue. Our approach encourages innovation and healthy debate, as we seek to build a team of dedicated partners who contribute to our collective success. We are passionate about empowering our employees, helping them grow both personally and professionally. This unwavering focus on team culture and individual development is the cornerstone of our ongoing achievements.

As a Risk Adjustment Coder, ensure high-quality and timely coding of diagnoses and procedures in a multi-specialty clinic using ICD-10, CPT-4, and HCPCS coding systems to fulfill billing requirements. Collaborate with physicians, technicians, insurers, and other key parties to review and discuss coding analysis outcomes. Oversee the coding program to maintain high standards and punctuality in a multi-specialty clinic setting. Enforce company policies and procedures that influence immediate operations and potentially have a broader organizational effect. Analyze complex issues requiring a deep understanding of organizational goals. Apply strategic policies and choose methods and evaluation criteria to achieve precise results.

This role involves coding and abstracting patient encounters, encompassing diagnostic and procedural information, significant reportable elements, and complications. It entails researching and analyzing data for reimbursement, examining medical records to find documentation gaps, and acting as a resource and expert for other coding staff. The job includes reviewing and confirming documentation supporting diagnoses, procedures, and treatment outcomes, identifying diagnostic and procedural information, and auditing clinical documentation and coded data to ensure it substantiates services provided for reimbursement and reporting. Responsibilities also include coding for reimbursements, research, and compliance with regulatory requirements following established guidelines, adhering to coding conventions, and consulting with care providers on coding matters. The position requires identifying discrepancies, potential quality of care, and billing issues, researching, analyzing, recommending, and implementing plans of action to rectify discrepancies and prevent future coding errors with the Director"s approval. It also involves identifying reportable elements, complications, and other procedures, serving as a resource and expert to other coding staff, assisting the Department Manager in training and mentoring staff, providing ongoing training as necessary, and managing special projects upon request.

Required Skills and Abilities:

- Certified Professional Coder

- ICD-10: 2 years of experience

- CPT coding: 2 years of experience

- Medical Coding: 2 years of experience

Preferred Skills and Abilities:

- Knowledge of Athena EMR

Education and Experience:

- High School Diploma or equivalent.

- Capable of multitasking, prioritizing, and managing time efficiently.

- Self-motivated and self-directed, with the ability to work independently.

- Excellent verbal and written communication skills.

- Proficient in computer skills, including Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel).

- Strong customer service skills, comfortable addressing questions from patients and insurance companies.

- Competent in analyzing problems and strategizing for better solutions.

- Executes company policies and procedures that impact immediate operations and may have an organization-wide effect.

- Complies with all official coding rules and CMS guidelines for risk adjustment reporting, ensuring accuracy, completeness, specificity, and appropriateness of diagnosis information.

- CPC - Certified Professional Coder.

- CRC - Certified Risk Adjustment Coder.