A Risk Adjustment Coding Auditor is an expert on current Medicare coding and billing requirements , ICD-10 and CMS regulations. The coder conducts retrospective and prospective audits of HCC coding by means of pre-visit planning and post visit reviews in addition to:
- Performing coding quality audits and evaluating clinical documentation of provider charts to support CCD, HCC, Risk Adjustment and ensures the proper level of payment.
- Uses claims data provided by Edifecs/Health Fidelity reports, performs suspect condition identification and validation.
- Collects and analyzes data to formulate recommendations and solutions based on audit trends and results.
- Provides regular feedback to leadership on performance improvement opportunities as a result of performance gaps.
- Develops and participates in orientation and continuing education of providers, clinical staff and ambulatory coders.