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Texas Health Resources Coding and Education Compliance Auditor - HCC in Dallas, Texas

Texas Health Organization for Physicians seeks to hire a Coding & Education Compliance Auditor to work Full Time in the Compliance Department.

The address is 9250 Amberton Parkway, Dallas, TX 75243.

Salary range is Minimum $24.53/hr. to Maximum $43.10/hr. – based on relevant experience

Work Schedule:

  • Full Time; 40 Hours

  • Monday – Friday; 1 st Shift

Job Description:

Handle Health plan inquiries regarding HCC audit results. Conduct focused HCC reviews on provides and clinics, tracking results and identifying trends and deficiencies for follow up training. Perform other duties to support the pre-bill, responding to emails and calls regarding Provider or Regional Director inquires. Ensure compliance with all applicable Federal and State Laws and regulations related to coding and documentation guidelines for Risk Adjustment.

  • Audit Providers and educate on HCC/Risk Adjustment guidelines and best practices.

  • Onsite – multiple locations throughout Dallas/Fort Worth metroplex.

  • Conduct focused HCC reviews on providers and clinics, tracking results and identifying trends and deficiencies for follow-up training.

  • Handle Health plan inquiries regarding HCC audit provider results.

  • Create educational materials for HCC specific methodology and presents training to providers with identified deficiencies.

  • Independently research complex coding issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and Federal Register.

  • Comply with official coding rules and guidelines.

  • Abide by the standards of ethical coding as set forth by the American Health Information Management Association (AHIMA).

  • Reviews outpatient medical records on both a retrospective and prospective basis to ensure documentation accurately reflects and supports code selection based on the ICD-10 coding guidelines, which are submitted to CMS for reimbursement based on the CMS Hierarchical Condition Categories (HCC) conditions that are applicable Medicare Risk Adjustment reimbursement initiatives.

  • Performs physician quires as needed to validate ICD-1 diagnosis codes.

  • Support current Compliance Coding & Billing Analyst with pre-bill process including handling email, and telephone Provider or Regional Director inquiries.

Qualifications

The ideal candidate will possess the following qualifications:

• High School Diploma or Equivalent required

• Bachelor’s Degree preferred

• 4 years Clinical coding documentation required and

• 2 years HCC Risk adjustment experience and physician billing/claims audits required

Licenses and Certifications:

• CRC – Certified Risk Adjustment Coder upon hire required

• CPC – Certified Professional Coder upon hire required or

• CCS–P – Certified Coding Specialist – Physician based upon hire required

Skills and Abilities:

• Risk Adjustment methodology experience preferred

• Proficient knowledge of CMS-HCC Model and guidelines

• Ability to interpret, analyze and abstract data/documentation

• Ability to identify HCC improvement opportunities and provide feedback to physicians on proper clinical documentation, compliance, and coding guidelines

• Excellent organization and problem-solving skills required

• Strong oral and written communication skills required

• Strong time management skills required

• Ability to work in a continuously changing environment

• Must possess a high degree of accuracy, efficiency and dependability

• Ability to work effectively as team member

Why Texas Health Resources?

Texas Health Organization for Physicians (THOP) is Texas Health Resources' 501(a) not-for-profit health corporation offering employment opportunities for administration staff that service providers of Texas Health Physicians Group (THPG). THOP provides services for member physicians that help them get back to what they do best -- practice medicine. From an affordable electronic medical record to comprehensive practice support services and group purchasing power, physicians and their patients benefit from being a part of THPG.

Texas Health Highlights:

• 2019 FORTUNE Magazine’s “100 Best Companies to Work For®” (5th year in a row)

• 2018 Becker's Healthcare "150 Great Places to Work in Healthcare" (4th year in a row)

• Employees’ Choice “Best Places to Work” by Glassdoor (2018 & 2019)

Employment opportunities are only reflective of wholly owned Texas Health Resources entities.

We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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