Quality Assurance Auditor Location: Remote Duration: 5-6 Months Description: The Medical Coding Specialist: HCC Coder working under the direction of the Manager of Risk Adjustment, determines the appropriate ICD-10 diagnoses codes based on clinical documentation that follows the Official Guidelines for Coding and Reporting and Risk Adjustment guidelines for Hierarchical Condition Categories (HCC). HCC Coding is a risk adjustment model designed to estimate future costs for patients. HCC coding relies on ICD-10-CM coding to assign risk scores to patients. The Coding Specialist reviews retrospective medical record documentation and ensures that the codes are appropriately assigned and capture the chronic conditions and disease burden of the Client members while providing accurate documentation to be utilized in coding per CMS’ guidelines. Specialist assists in profiling and outcomes and specifically in second pass review with vendor partnerships. The HCC Coder utilizes standards of compliance, and clinical knowledge to identify opportunities and to achieve results. Responsibilities: Review documentation available in the Medical Record to facilitate workflows that support the clinical documentation of illness and the patient care rendered to Client members. Reviews medical records for second pass and identifies potential deletes that vendor partnerships did not identify. Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM diagnosis codes mapped to HCCs. Ensure documentation in the medical record follows the official coding guidelines that Client adheres to. Create and analyze reports for coding improvement trending and high-level dashboards for ongoing monitoring and opportunities. Provide ongoing feedback and participate in education programs for physicians and other providers regarding coding guidelines and requirements. Education Minimum: High School diploma or equivalent and Medical Coding Education Preferred: Associate degree in a healthcare related field Work Experience Minimum: One (1) year of progressive coding experience Preferred: Two (2) years progressive coding experience in multiple specialties, HCC Risk adjustment Coding Licenses & Certifications Minimum: Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) and/or Certified Clinical Documentation Specialist- Outpatient or Certified Documentation Expert Outpatient (CDEO) Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required Preferred: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) Required Skills, Knowledge, and Abilities Willing to work as a team innovation and collaboration is a priority Experience with Electronic Medical Record (EMR) Systems such as EPIC and Cerner Knowledge of AHA coding guidelines and methodologies: HCCs, ICD-10-CM coding guidelines, Office of Inspector General (OIG) and Federal and State regulations Extensive knowledge of medical terminology, anatomy, and pathophysiology, pharmacology, and ancillary test results Proficient with Microsoft Office applications (Outlook, Word, Excel) Self-motivated and able to work independently without close supervision Strong communication skills (interpersonal, verbal and written) As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.