Risk Adjustment Auditor I-18012754
Company: Baylor Scott White Health
Posted on: September 13, 2018
Risk Adjustment Auditor I
The RiskAdjustment Auditor I for Baylor Scott and White Health (BSWH) is responsiblefor reviewing member records to accurately maximize risk scoring in keepingwith Scott and White Health Plan (SWHP) risk adjustment strategies andprocesses for lines of business subject to risk adjustment. He / She is responsiblefor conducting provider audits and creating/presenting training and educationto providers on Risk Adjustment Methodology.
In addition, the Risk Adjustment Auditor I for BSWH has the followingresponsibilities:
Interpret health record documentation using knowledge of anatomy,physiology, pathological processes of disease, and medical terminology to codeand abstract diagnoses and/or procedures for inpatient, outpatient, and cliniccases
Abstract pertinent information from data files and records and isable to accurately transfer or coordinate transfer into the appropriate HealthPlan System or Risk Adjustment Software
Evaluate the impact of code selection on the Risk Adjustmentassignment to ensure proper level of payment
Conduct focused HCC reviews on providers and clinics, trackingresults and identifying trends and deficiencies for follow-up training
Create educational materials for HCC specific methodology andpresents training to providers, 1:1 or in groups
Work in collaboration with medical services, provider relations,configuration, claims, medical informatics and information systems staff onassigned projects to identify required coding sets for tracking/trending fordata for multi-use reporting purposes
Assist SWHP Provider Audit Committee as needed with providerdocumentation reviews related to coding on claims to identify potential fraud,waste or abuse related to coding
Independently research complex coding issues and keeps abreast ofcoding and compliance changes as communicated by CMS, HHS, AHA, AMA and theFederal Register
Abide by the standards of ethical coding as set forth by theAmerican Health Information Management Association (AHIMA)
Comply with official coding rules and guidelines to ensure highquality health information and accurate claims submission
Demonstrate behavior that reflects integrity, supportsobjectivity, and fosters trust in professional activities
Protect data integrity and validity
Respect patient confidentiality for accessing and disclosure ofhealth information
The idealcandidate will possess the following knowledge, skills and abilities:
Knowledge of ICD-9-CM and CPT coding conventions, and clinicaldocumentation.
HCC experience preferred
Experience providing physician feedback
Group training experience preferred
Ability to pass in-house coding exam with 90% or above
Knowledge of Microsoft Word, Excel, and PowerPoint
One of the following certifications are required: RHIT, RHIA, CPC, COC, CCS, CCS-P, CIC, CFPC,CEMC, CIMC or CRC
Location/Facility - Baylor Main Hospital Temple- Ground Floor
Formore information on the facility, please click our Locationslink.
Specialty/Department/Practice - HIM/ Coding
Shift/Schedule - Days/ Full Time
Benefits - Our competitive benefitspackage includes*:
Immediate eligibility forhealth and welfare benefits
401(k) savings plan withdollar-for-dollar match up to 5%
PTO accrual beginning Day1
*Note: Benefits may vary based upon position type and/orlevel.
BaylorScott & White Health (BSWH) is the largestnot-for-profit health care system in Texas and one of the largest in the UnitedStates. With a commitment to and a trackrecord of innovation, collaboration, integrity and compassion for the patient,BSWH stands to be one of the nation's exemplary health care organizations. Our mission is to serve all people by providing personalizedhealth and wellness through exemplary care, education and research as aChristian ministry of healing. Joining our team is not just accepting a job,it's accepting a calling!
Associate'sDegree or Equivalent Experience
2years of experience
CPC,COC, CCS, CCS-P, CIC, CFPC, CEMC, CRC, RHIT, or RHIA Certification Required.
Bachelor'sdegree and 0 years of experience
Associate'sdegree and 2 years of experience
HighSchool Diploma/GED and 4 years of experience
Main Hospital - Ground floor (10790)
2401 South 31st Street
Keywords: Baylor Scott White Health, Temple , Risk Adjustment Auditor I-18012754, Accounting, Auditing , Temple, Texas
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