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RISK ADJUSTMENT/CODER AUDITOR in San Diego, CA at Scripps Health Plan Services -4S Ranch

Date Posted: 1/20/2019

Job Snapshot

Job Description

At Scripps Health, you will experience the pride, support, respect that has been repeatedly recognized as one of the nation’s Top 100 Places to Work.
You’ll be surrounded by people committed to making a difference in the lives of their patients and their teammates. So if you’re open to change, go ahead and unlock your potential.
Join a highly cohesive team with in the Financial Services Department at Scripps Healthcare as a Risk Adjustment/Coder Auditor.  This is a highly engaged team that is cross trained and works collaboratively daily to accomplish their tasks in a team approach.
The Risk Adjustment/Coder Auditor provides risk adjustment coding and educational support to the physician, leaders, sites, and support staff, and other coder/auditors related to risk adjustment. Participates is risk adjustment coding education in the form of audits, email alters, training materials and onsite presentations. Conduct audits of medical record documentation for HCC abstraction, interprets medical records and chart entries on coding and RAF determinations. Collaborates in problem resolution, proactive strategies, and identification of best practices. Utilizes multiple reports related to risk adjustment to determine focus audit or educational outreach and initiatives directly affecting reimbursement. Reviews and updates encounter documents on a continuous basis, ensuring completeness and accuracy. Ensures billing edit reports are resolved in an efficient manner with identification of problem trends affecting HCC. Communicates effectively both verbally and in written format on correspondences related to risk adjustment.
This is a Full Time, 8 hour day, Monday – Friday position located at our Scripps Office in Rancho Bernardo/4S Ranch. (80 hours per Biweekly pay period)

Job Requirements

Required Education/Experience/Specialized Skills:
  • Minimum of three (3) years' experience in coding, medical documentation auditing in a multi-specialty setting, ambulatory care setting.
  • Demonstrates proficiency in the use of ICD-9/ICD-10 and CPT coding guidelines; ability to abstract and interpret medical records, predictive analytics and reports; highly organized; ability to educate and train all levels of professional staff.
Required Certification/Registration:
  • Required Certified Coding Specialist (CCS) Certification from the American Health Information Management Association (AHIMA) and/or (CPC) Certification from the American Association of Certified Coders (AAPC)
  • CRC Risk Adjustment certification from AAPC to be obtained within one year of hire date if not currently already certified.
Preferred Education/Experience/Specialized Skills/Certification:
  • Bachelor's degree and/or college coursework in a related field.
  • ICD-10 Certification.
Scripps Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with disability.