HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA *Remote*

Description

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Providence Health Plan is calling an HCC Risk Adjustment QA Auditor: Medicare Advantage & ACA who will:

Perform internal coding audits of hierarchical condition category (HCC) coding review for Risk Adjustment staff, contractors, and vendors

Perform audits to ensure compliance with national coding guidelines and industry regulations, as well as adherence to Providence Health Plans coding policies

Review appropriate ICD-10-CM code assignments on risk adjustment retrospective and prospective projects

Partner with the coding team, Supervisors, and Director to improve the accuracy, integrity, and quality of coding practices as well as to ensure minimal variation in coding practices

Identify coding issues and report issues to Supervisor or Director

Provide coder specific education based on audit findings and trends

Perform HCC abstract reviews, chart reviews, and other reviews as assigned

Providence Health Plan welcomes applicants to apply who reside in the following States:

Oregon

Washington

Please note the following important detail regarding this role:

This position is affiliated with Providence Health Plan and will be tied to a location and compensation range in Beaverton, Oregon

Required qualifications for this position include:

5 years HCC specific coding experience

3 years of recent auditing experience

Proficiency in Microsoft Excel, Word, and various EMR systems

Active Certification in one or more of the following: RHIT, RHIA, CCS, or CPC

Preferred qualifications for this position include:

Bachelors Degree -OR- a combination of equivalent education and experience

Active Certification: CRC

Why Join Providence Health Plan?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 318654
Company: Providence Jobs
Job Category: Coding
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift:
Career Track: Business Professional
Department: 5018 GA ASO OR REGION
Address: OR Beaverton 3601 SW Murray Blvd
Work Location: Murray Business Ctr Beaverton-Beaverton
Workplace Type: Remote
Pay Range: $34.96 – $55.34
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.