JOB SUMMARY

Accountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health risk adjustment strategies and processes for lines of business subject to risk adjustment.

Salary Range:

The pay range for this position is $26.66/hr (entry-level qualifications) - $40/hr (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience.

ESSENTIAL FUNCTIONS OF THE ROLE

Conducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology

Interprets health record documentation to code and abstracts diagnoses and/or procedures for inpatient, outpatient, and clinic cases

Conducts focused HCC reviews on providers and clinics, tracks results and identifies trends and deficiencies for follow-up

Researches complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and the Federal Register, and sharing knowledge with co-workers, as directed

Assists Risk Adjustment Auditor 2 or Manager with educator duties in the clinics on occasional based, as needed

Protects data integrity and validity

Maintains and respects patient confidentiality for accessing and disclosure of health information

KEY SUCCESS FACTORS

Knowledge of ICD-10-CM and CPT coding conventions, and clinical documentation

Knowledge of and compliance with standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC)

Knowledge of anatomy, physiology, pathological processes of disease, and medical terminology

Critical thinking skills for chart review and abstraction

Efficient Time Management skills

Proficiency in use of Microsoft applications such as Word, Excel, and PowerPoint preferred

BENEFITS

Our competitive benefits package includes the following:

Immediate eligibility for health and welfare benefits

401(k) savings plan with dollar-for-dollar match up to 5%

Tuition Reimbursement

PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

EDUCATION - Associate's or 2 years of work experience above the minimum qualification

EXPERIENCE - 2 Years of Experience

CERTIFICATION/LICENSE/REGISTRATION

Cert Coding Specialist (CCS), Cert Coding Spec Physician Bas (CCS-P), Cert Professional Coder (CPC), Reg Health Info Administrator (RHIA), Reg Health Information Technic (RHIT): Must have one of the following:

CCS - Certified Coding Specialist

CCS-P - Certified Coding Specialist-Physician Based

CPC - Certified Professional Coder

RHIA - Reg Health Info Administrator

RHIT - Reg Health Information Technician.

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.