Medical Coding Audit Specialist

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER

1.0 FTE / 40 hours per week.

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard. Join our team and receive training, resources, competitive pay and exceptional benefits including free parking at all our locations! Check us out by clicking on Many Talents, One Mission! The Benefits of Working at GHC-SCW.

The Medical Coding Audit Specialist - Risk Adjustment is responsible for chart retrieval, medical record review, HCC identification and data quality oversite for risk mitigation and revenue recovery for ACA risk adjustment services. Assists in the development and management of activities in support of HCC coding while ensuring compliant practices for revenue management and reducing risk. Helps in the preparation with all Risk Adjustment Data Validations (RADV) audits as well as serving as the CMS liaison for REGTAP webinars and communications. Determines adequacy and correctness of physician diagnosis/documentation as it relates to risk adjustment.

As assigned, the incumbent may assist the Medical Coding Supervisor in various administrative tasks. The Medical Coding Audit Specialist works under the general supervision and guidance of the Revenue Cycle Manager.

Job Specific Minimum Qualifications

1. High school graduation or equivalent is required.
2. Completion of an accredited Medical Coding Specialist Program or equivalent combination of education and/or relevant work experience is required.
3. Certification as a CPC or CCS-P is required.
4. Ability to obtain Certified Risk Adjustment Certification (CRC) from American Academy of Professional Coders (AAPC) within 6 months of hire.
5. Five (5) years' experience to include medical chart reviews, risk adjustment experience with in-depth working knowledge of CPT coding, ICD 9 and 10 coding, medical terminology, and solid working knowledge of HCC coding is required.
6. Knowledge of medical terminology, basic anatomy, physiology, and disease process is required.
7. Knowledge of Medicare and Medicaid rules and regulations is required.
8. Knowledge of or ability to learn various computer programs such as MS Office Suite, word processing, database, calendar and email is required. Knowledge of or ability to learn and effectively use systems including electronic medical record and electronic coding systems is required. Experience with EPIC is highly desirable.
9. Excellent oral and written communication skills are required.
10. Excellent customer service skills and the ability to work with a diverse patient population is required. Ability to work harmoniously and cooperatively with all staff and the public is required.
11. Ability to identify coding needs and code accurately is required.
12. Excellent organizational, analytical and problem-solving skills are required.
13. Ability to maintain personnel related and patient confidentiality is required. Knowledge of or ability to learn HIPAA requirements.
14. Ability to negotiate with individuals, including practitioners, is required.
15. Ability to adhere to OSHA standards and other patient care protocols is required.
16. Ability to travel among GHC sites on short notice is required.
17. Professional manner necessary to deal courteously and effectively with patients and the public.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.

Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.

Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values

• We are a not-for-profit Cooperative
• We are member-centered
• We are equitable and inclusive
• We are quality-driven
• We are innovative
• We are community involved

We believe:

Healthcare is a human right.

In treating all people with dignity and respect.

There is strength in diversity.

Equity celebrates our humanity.

We are better together.

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

• Administration - 1265 John Q. Hammons Drive, 1265 John Q. Hammons Dr. , Madison, Wisconsin, United States of America