QHP Auditor (AHA)

Responsibilities• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CMcodes 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 stateand 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 CodingGuidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with allstate 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 Adjustmentcoding.• Completion of an accredited medical coding program with current unencumbered credentials.Required education:• CPC CertificationRequired experience:• Risk Adjustment coding: 5 years.• Coding: 7 yearsSupervision Received• General supervision is received weekly