Data Quality Auditor

Job Description: • Responsible for performing audit and abstraction of medical records (provider and/or vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) • Proven ability to support coding judgment and decisions using industry standard evidence and tools • Proficient in abstraction and assignment of accurate medical codes for diagnoses as documented by physicians and other qualified healthcare providers in the office and/or facility setting • Sound knowledge of coding guidelines and regulations to meet compliance requirements, such as establishing medical necessity • Identify clinically active vs. historical conditions • Diagnosis codes must be appropriate, accurate, and supported by clinical documentation • Utilize medical records to ensure support is documented for etiology and manifestations of disease processes • Adhere to stringent timelines consistent with project deadlines and directives • Conducts self-process audits to ensure compliance with internal policies and procedures as well as regulatory guidance from CMS, OIG or other Regulatory body. Requirements: • Minimum of 1 year recent and related experience in medical record documentation review, diagnosis coding, and/or auditing • AA/AS or equivalent experience • Completion of AAPC/AHIMA training program for core credential (CPC, CCS-P) with associated work history/on the job experience equal to approximately 1-2 years for CPC • CPC (Certified Professional Coder) or CCS-P (Certified Coding Specialist-Physician) required • CRC (Certified Risk Adjustment Coder) • Computer proficiency including experience with bolthires Office products (Word, Excel, Access, PowerPoint, Outlook, industry standard coding applications) • Experience with International Classification of Disease (ICD) codes required • Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition Categories (HCC) preferred. Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-bolthires programs for all colleagues including wellness screenings, tobacco cessation and weight management programs • Confidential counseling and financial coaching • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Apply tot his job Apply tot his job