BSWHP Risk Adjustment Auditor I

JOB SUMMARY for BSWHP (Baylor Scott & White Health Plan)Accountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health strategies and processes for lines of business subject to risk adjustment.SALARY RANGEThe pay range for this position is $26.27/hr (entry-level qualifications) - $39.41/hr (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.ESSENTIAL FUNCTIONS OF THE ROLEConducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology.Interprets health record documentation to code and abstract diagnoses and/or procedures for inpatient, outpatient, and clinic cases.Conducts focused HCC reviews on providers and clinics, tracks results, and identifies trends and deficiencies for follow-up.Researches complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA, and the Federal Register, sharing knowledge with co-workers as directed.Assists Risk Adjustment Auditor 2 or Manager with educator duties in the clinics on an occasional basis, as needed.Protects data integrity and validity.Maintains and respects patient confidentiality for accessing and disclosing health information.KEY SUCCESS FACTORSKnowledge of ICD-10-CM and CPT coding conventions, and clinical documentation.Knowledge of and compliance with standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC).Knowledge of anatomy, physiology, pathological processes of disease, and medical terminology.Critical thinking skills for chart review and abstraction.Proficiency in the use of Microsoft applications such as Word, Excel, and PowerPoint preferred.BENEFITSOur competitive benefits package includes the following:Immediate eligibility for health and welfare benefits.401(k) savings plan with dollar-for-dollar match up to 5%.Tuition Reimbursement.PTO accrual beginning Day 1.Note: Benefits may vary based upon position type and/or level.QUALIFICATIONSEDUCATION - Associate's degree or 2 years of work experience above the minimum qualification (with 2 years below, no degree = 4 years of experience needed to qualify).EXPERIENCE - 2 Years of Experience, preferably in healthcare risk adjustments.CERTIFICATION/LICENSE/REGISTRATIONMust have one of the following:CCS - Certified Coding Specialist.CPC - Certified Professional Coder.As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviors that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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