QHP Auditor (AHA) - Resource Logistics, Inc.
Charlestown, MA 02129
About the Job
Responsibilities
" Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM
codes are accurately assigned and supported by clinical documentation. Primarily for QHP
(RADV)
" Ability to code government and state models. This includes code everything projects.
" Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state
and federal regulations.
" Ability to maintain a 95% accuracy rate on all coding projects.
" Coders assist with code abstraction and coding quality audits using the Official Coding
Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all
state regulations, federal regulations, internal policies, and procedures.
Requirements
" Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.)
The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
" RADV Experience Mandatory
" Strong organizational skills
" Technical savvy with high level of competence in basic computer skills, Microsoft Outlook,
Word, Excel, and Outlook.
" Strong written and verbal communication skills
" Ability to work independently in a remote environment.
" Private lockable office space to ensure security of Member PHI
" Minimum of 7 years coding experience with at least 5 of those years in Risk Adjustment
coding.
" Completion of an accredited medical coding program with current unencumbered credentials.
Required education:
" CPC Certification
Required experience:
" Risk Adjustment coding: 5 years.
" Coding: 7 years
Supervision Received
" General supervision is received weekly
" Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM
codes are accurately assigned and supported by clinical documentation. Primarily for QHP
(RADV)
" Ability to code government and state models. This includes code everything projects.
" Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state
and federal regulations.
" Ability to maintain a 95% accuracy rate on all coding projects.
" Coders assist with code abstraction and coding quality audits using the Official Coding
Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all
state regulations, federal regulations, internal policies, and procedures.
Requirements
" Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.)
The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended.
" RADV Experience Mandatory
" Strong organizational skills
" Technical savvy with high level of competence in basic computer skills, Microsoft Outlook,
Word, Excel, and Outlook.
" Strong written and verbal communication skills
" Ability to work independently in a remote environment.
" Private lockable office space to ensure security of Member PHI
" Minimum of 7 years coding experience with at least 5 of those years in Risk Adjustment
coding.
" Completion of an accredited medical coding program with current unencumbered credentials.
Required education:
" CPC Certification
Required experience:
" Risk Adjustment coding: 5 years.
" Coding: 7 years
Supervision Received
" General supervision is received weekly
Source : Resource Logistics, Inc.
