Vista Community Clinic

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Quality Coder/Auditor

at Vista Community Clinic

Posted: 2/12/2019
Job Reference #: 2151
Keywords: compliance

Job Description

  • Req No.
    2019-2151
    Location
    US-CA-Vista
    Type
    Regular Full-Time
    Department
    Finance
    Schedule
    40 hrs/wk (M-F 8:30 am to 5:00 pm)
  • Overview

    Vista Community Clinic is a private, non-profit medical, dental, optometry, chiropracty, behavioral and social services center providing care in a comprehensive, high quality setting. We provide the highest quality services in seven clinics located in San Diego, Orange and Riverside counties. We work to advance community health and hope by providing access to premier health services and education for those who need it most. We are looking for dedicated, motivated, enthusiastic team players who want to serve our population. You will make a difference in the lives of others. Every day, you will make an impact on your community.

    We have a very competitive compensation and benefits program which includes health, dental, vision, company-paid life, AD&D & disability insurance, flexible spending accounts and a 403(B) plan, for eligible employees.

    VCC is an equal opportunity employer.

    Responsibilities

    • Responsible for system wide requirements for accuracy in documentation to include ICD-10 and CPT codes, making sure Quality Measures and Preventive services are completed for patients required by Managed Care, CMS, and Medicare Advantage guidelines.
    • Creates Code Crosswalk for all Managed Care Contracts regarding HEDIS annually.
    • Collaborates with IT and other departments as needed to ensure appropriate ICD-10 and CPT codes are updated annually in Electronic Medical Records (EMR).
    • Identifies opportunities for improvement and applies appropriate process improvement methodologies.
    • Review patient medical records for HEDIS measures determined by the organization.
    • Accurately audit and review diagnoses codes to ensure highest level of specificity.
    • Accurately audit and review CPT procedures for appropriate services.
    • Reviews and updates encounter documents on a continuous basis, ensuring completeness and accuracy with identification of problem trends affecting HCC, communicates correct coding to Clinicians.
    • Assist in the development of training materials with Quality Manager and Quality staff.
    • Responsible for developing audit tools and reports.
    • Assist Quality Manager/Quality staff in writing/establishing operating procedures to meet coding regulations/compliance and follow-up enhancement.

    Qualifications

    Minimum

    • High school graduate or equivalent
    • Coding certification, preferably HCC Coder (Certification from AHIMA and/or AAPC)
    • Minimum three years medical coding experience
    • Minimum two years medical auditing experience

    Preferred

    • Two years' experience in an FQHC environment
    • Experience with NextGen
    • Coding compliance program implementation experience
    • Knowledge of Quality metrics and HEDIS
    • Possess ability to proficiently use Microsoft suite of products; Excel, Outlook, Word, PowerPoint.

    Required Skills/Knowledge/Abilities

    • Knowledge of Medicare, Medi-Cal/Presumptive Eligibility, FPACT, Every Woman Counts, Tricare and Managed Care Payors
    • Knowledge of payer coding policies and guidelines for FQHC’s
    • Familiar with medical terminology
    • Proficient with MS Office and data entry skills
    • Ability to perform a high volume of detail work with speed and accuracy
    • Ability to communicate initiatives, results and analyses, to multiple levels of management

    Application Instructions

    Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!