QHP Auditor (AHA)

Job Description

• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM
• codes 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 state
• and 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 Coding
• Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all
• state 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 Adjustment
• coding.
• Completion of an accredited medical coding program with current unencumbered credentials.
• Required education:
• CPC Certification
• Required experience:
• Risk Adjustment coding: 5 years.
• Coding: 7 years
• Supervision Received
• General supervision is received weekly
• Not looking for:
• Only a CRC
• Applicants that say they are CDI
• Former Managers
• Constant job hoppers: Call out past temp experience, seeking people with log assignments, many extensions, or long permanent employment.

Job Requirements

Cco, Cdi, Outlook, Cms, Cro, Computer Skills, Verbal Communication Skill, Government, Vat, Education, Ned, Verbal Communication Skills, Visio, Auditing, Organizational Skills, Excel, Communication Skill, Written And Verbal Communication, Organizational Skill, Documentation, Supervision, Communication Skills, Work Independently

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