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Coding Auditor - Risk Adjustment --------------------------------------------------------------- The Coding Auditor performs code audits and is responsible for chart auditing processes as well as contributing to the education of providers and internal stakeholders on coding topics. The position is responsible for keeping up to date on the newest coding guidelines and best practices while promoting compliance with existing American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. Specific approaches to job duties vary depending on the department. Estimated Hiring Range: $72,765.00 - $88,935.00 Bonus Target: Bonus - SIP Target, 5% Annual Current CareOregon Employees: Please use the internal Workday site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities * Perform and assist with a variety of coding-related audits for providers and other entities. * Assist with RADV and other diagnosis code related audits (Applies to Finance department roles only). * Review medical records to verify that complete and accurate diagnosis codes are captured in claims and retrospective chart review data. * Communicate audit results and recommendations for improvement to providers when needed. * Create and maintain processes for tracking audit results and outcomes of reviews. * Identify, track, analyze and report on any trends revealed in audits. * Develop and maintain centralized policy, process and compliance-related documentation and training resources to support the education of providers and internal stakeholders. * Develop or assist with the development of educational materials and process documentation in a variety of mediums (e.g., recorded training sessions, reference documentation, etc.). * Actively maintain up-to-date knowledge of coding guidelines and applicable state and federal regulations by frequently referencing current ICD-10-CM and CMS manuals, reviewing professional publications, and attending educational workshops/conferences. * Maintain active coding certification. * Seek out emerging coding best practices using a variety of strategies (e.g., establishing personal networks, participating in professional associations, etc.). * Serve as subject matter expert regarding correct coding practices. Organizational Responsibilities * Perform work in alignment with the organization’s mission, vision and values. * Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. * Strive to meet annual business goals in support of the organization’s strategic goals. * Adhere to the organization’s policies, procedures and other relevant compliance needs. * Perform other duties as needed. Experience and/or Education Required * Minimum 2 years’ experience as certified coder * Active coder certification through AHIMA or AAPC * For Finance Department only: Current Certified Risk Adjustment Coder (CRC) or completion within one year of hire Preferred * Certified Documentation Improvement Practitioner (CDIP) or Certified Documentation Expert Inpatient or Outpatient (CDEI or CDEO) * Experience leading group educational presentations and teaching to medical professionals * Experience with or knowledge of risk adjustment principles (applies to roles in Finance/Risk Adjustment department) Knowledge, Skills and Abilities Required Knowledge * Extensive knowledge of diagnosis coding conventions as defined by CMS and AMA Skills and Abilities * Ability to read and comprehend medical terminology and medical chart notes * Ability to make independent decisions on ICD-10 and CPT code assignments (Risk Adjustment department) * Ability to work proficiently with job related systems, specifically electronic health record (EHR) software systems * Ability to learn new systems and applications as needed * Intermediate level skills with Microsoft office products (PowerPoint, Excel, Word, etc.) * Analytical, problem-solving and research skills * Ability to effectively work and interface with teammates, vendors, and management * Proficient written and spoken communication skills * Ability to effectively teach and coach adult learners and communicate technical information clearly * Ability to present information, written or oral, to team members, management and external provider groups, including medical professionals * Strong attention to detail and problem-solving skills * Ability to work autonomously in a fast-paced production environment while maintaining a high standard of quality * Ability to work well under pressure, remain focused and meet deadlines * Ability to use good judgment and discretion to perform job responsibilities * Ability to adhere to governmental as well as organizational standards, policies and procedures (HIPAA, Ethics, Privacy, etc.) * Ability to work effectively with diverse individuals and groups * Ability to learn, focus, understand, and evaluate information and determine appropriate actions * Ability to accept direction and feedback, as well as tolerate and manage stress * Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day * Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer CareOregon is an equal opportunity employer.  The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and our work as part of Health Share of Oregon. We also support recruitment for The Collaborative. Our mission is to inspire and partner to create quality and equity in individual and community health. Our vision is healthy communities for all individuals, regardless of income or social factors. Making Healthcare Work for Absolutely Everyone. Let's connect! Add your resume to our Talent Community to stay up to date with relevant career opportunities. Learn more about our benefits and joining CareOregon Click here for more information about jobs at Housecall Providers, part of the CareOregon family. We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status. Veterans CareOregon greatly encourages military veterans to apply. CareOregon is a major sponsor of the annual Portland Veterans Stand Down and hiring fair. Ranked #8 in the Health Care Category. Read more about the culture at CareOregon