ACO Coding Auditor

Overview:

Cano Health fosters a culture driven by providing superior primary care services in the communities we serve, while forming lifelong bonds with our members. Guided by our mission to improve the health, wellness, and quality of life of our patients, Cano Health continues to work towards making a difference in primary healthcare.

At Cano Health, our cultural attributes are to be patient centered, service focused, results oriented, trustworthy, transparent, and to continuously improve. Join our collaborative team, dedicated to the pursuit of excellence in health and wellness.

Cano Health offers competitive salaries, medical, dental & vision insurance, employee mental health program, paid time off, paid holidays, 401(k) with employer match, employee stock purchase program, tuition reimbursement and much more.

The ACO Coding Auditor is responsible for reviewing medical records and identifying, collecting, assessing, monitoring and documenting claims and encounter information as it pertains to Medicare Risk Adjustment. You implement ongoing quality improvement activities to assure the Medicare Risk score meets all requirements and act as a consulting MRA advisor to the practices you support.  You review practices for both CMS and Commercial ACO’s for quality compliance.

• Performs on-site and remote clinical validation audits and interpretation of medical documentation to capture all Medicare Risk codes in coordination with the physician.
• Provides guidance and consultation to practice team members to drive improved MRA coding proficiency over time
• Verifies and ensures the accuracy, completeness, specificity, and appropriate coding based on CMS HCC categories
• Analyzes and translates medical and clinical diagnoses, procedures, and illnesses into Medicare Risk codes
• Reviews medical records, patient medical history and physical exams, physician orders, progress notes, consultation reports, diagnostic reports, operative and pathology reports, and discharge summaries
• Represent the Quality department with tracking open gaps to ensure HEDIS standards are meet as follow but not limited to: Part-D & Medication Adherence, Part-C & Preventive Care measures, Patient Experience and Audit Process
• Engage with practice management team members on applying correct steps into daily process including and no limited to module software on an ongoing basis
• Support affiliate medical centers to increase uniformity on the generalization on daily process where Quality data is collected
• Participates in audits and analyzes data to identify trends and improvement opportunities
• Performs ongoing analysis of medical charts to ensure all codes are reported timely and properly to CMS
• Ensures compliance with all applicable Federal, State, and/or County laws and regulations related to Medicare coding and documentation guidelines
• Facilitates education and/or educates providers and office staff on proper CMS Risk Adjustment coding, billing, pay for performance measurements and medical record review criteria
• Communicates with co-workers, management, and practice staff regarding documentation, claim submission and reimbursement issues
• Provides support and compliance through effective communication and training/education
• Participates in departmental and organizational quality management activities
• Cooperates with other personnel to achieve department objectives and maintain good employee relations, and interdepartmental objectives
• Attends departmental meetings as required
• Effectively manage special projects and other tasks as assigned
• Document and trend findings in identified database
• Any other duties or responsibilities?assigned

• High School diploma or GED required
• Required Certified Coder; CPC, CRC, CCS-P, CCS-H, RHIT
• 3+ years of Medicare Risk Adjustment experience
• Experience working in health care and insurance Industry

Cano Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.