Job Title

Job Description Under the direction of the Supervisor/Manager of HCC/Coding, this position is responsible for overseeing inventory from an HCC and Coding perspective, this includes working the inventory too. Individual will work to ensure team has adequate training and resources to effectively work the inventory. In addition, this position will serve as the liaison between the clinic team and the coding team regarding billing requirements. The Lead Auditor/Coder will interact with other departments and providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers 1.1 Under the direction of the Supervisor/Director of HCC/Coding, develop and maintain a process whereby inventoryprioritized/managed/audited in a timely manner. 1.2 Under the direction of the Supervisor/Director of HCC/Coding, develop and maintain training materials and job 1.3 Aids to ensure consistency in both auditing and coding. 1.4Identify and help develop workflow improvements to ensure we maximum efficiency/effectiveness in HCC and Quality Initiatives. 1.4 Audit Medical records for Staff Model and IPA providers for validation of all current HCC diagnosis on all Senior HMO Patients as well as future lines of business that may have an HCC component to them. 1.5 Communicate with providers regarding chart notes that need to be corrected in a timely manner (within one week of receiving and auditing the chart notes). 1.6 Query providers for potential HCC codes and chart note corrections to ensure all appropriate HCC diagnoses are being captured for each patient. 1.7 Interface effectively with providers and staff on coding issues and HCC documentation issues. 1.8 Code both clinic visits and professional hospital visits for HMO patients. 1.9 Provide ongoing training to the clinic staff on billing guidelines. 1.10 Assist with training new staff on auditing/coding and overall workflow as well as current Auditor 1/Coders that may needadditional training. 1.11 Position eligible for hybrid work schedule. 1.12 All other job duties as required. Requirements 8.1 High school diploma/certificate required. 8.2 Valid CPC, CCS-P or CMC coding certificate. 8.3 3-5 years of coding experience required with at least one year emphasis on HCC code validation required. 8.4 Leadership experience preferred. 8.5 Maintain membership and Continuing Education Unites (CEU's) for any Coding Credential(s) obtained. Reimbursementwill be given for membership and CEU's if employee turns in the original receipt for items purchased. 8.6 Comprehensive knowledge of CPT-4, ICD-10 and HCPCS codes and how to apply them. 8.7 Extensive understanding of Medical Terminology and Human Anatomy required. 8.8 Adherence to official Coding, CMS and other regulatory guidelines and mandates. 8.9 Ability to read and understand medical record documentation for HCC diagnoses extraction. 8.10 Intermediate skill level of Microsoft Word, Excel, Power Point, Outlook, and Access. 8.11 Knowledge of and adhere to HIPAA and Health Care compliance regulations. The pay range for this position at commencement of employment is expected to be between $33.85 and $39.83 however, base The pay range for this position at commencement of employment is expected to be between $33.85 and $39.83 however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience. If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.