Coding Auditor

Coding Auditor

AllCare Health | Quality Department | Grants Pass, Oregon

We Are Seeking Qualified Candidates to Join Our Team!

AllCare Health offers competitive wages and an excellent benefits package, including affordable healthcare, 401(k) retirement, wellness programs, and flexible scheduling options.

Summary of the Position

The Coding Auditor is responsible for developing, implementing, and maintaining auditing practices related to medical record coding and documentation to support accurate and complete risk adjustment outcomes for Medicare members.

This position reviews medical records and coding for accuracy and compliance with Centers for Medicare & Medicaid Services (CMS) Risk Adjustment Data Validation (RADV) requirements, identifies coding and documentation trends, and works collaboratively with providers and internal teams to improve documentation, coding accuracy, and risk adjustment outcomes.

Essential Duties

1. Ensures the accuracy and correlation of diagnosis codes, dates of service, medical record documentation, and other information used to support risk adjustment.

2. Identifies, analyzes, and communicates trends related to coding accuracy and documentation quality.

3. Develops and supports intervention and education strategies for healthcare providers to improve coding and documentation practices.

Job Duties

• Supports and contributes to AllCare’s mission, vision, and values.

• Reviews medical records and supporting documentation to ensure accurate Hierarchical Condition Category (HCC) coding and provides appropriate recommendations.

• Performs medical record reviews, including prospective, retrospective, and concurrent reviews, in accordance with established processes and timelines.

• Performs data analysis and prepares reports to support internal operations and external risk adjustment requirements.

• Maintains established productivity expectations and addresses assigned work queues within required timeframes.

• Maintains a minimum 95% accuracy standard across assigned coding and auditing projects.

• Identifies coding and documentation trends and provides coaching, feedback, and education to support coding accuracy and continuous improvement.

• Develops audit reports and communicates findings to providers and internal stakeholders in a clear, constructive, and actionable manner.

• Supports complex internal audits in accordance with established auditing standards, procedures, timelines, and management direction.

• Supports HEDIS medical chart auditing activities as needed.

• Supports compliance efforts by comparing medical record documentation with claims data and identifying discrepancies.

• Collects, organizes, analyzes, and communicates data to internal and external stakeholders to support quality and process improvement.

• Assists with the development and presentation of corrective action plans when coding, documentation, or control weaknesses are identified and monitors progress through resolution.

• Collaborates with the Provider Engagement team on provider outreach and education using coding expertise, audit findings, analytics, and industry best practices.

• Develops and maintains training materials related to medical record abstraction, data entry, HEDIS, risk adjustment, and applicable auditing processes.

• Researches coding guidance and participates in continuing education as necessary to maintain required professional certification.

• Monitors and maintains compliance with HIPAA requirements, organizational policies, and applicable regulatory standards.

• Maintains current knowledge of coding guidelines, payer requirements, CMS regulations, and risk adjustment requirements.

• Prepares reports, documentation, and other materials as required.

• Maintains punctual, regular, and predictable attendance.

• Works collaboratively within a team environment.

• Respectfully receives and follows direction from leadership.

• Completes all required training, including assigned Relias Learning Management System (LMS) training.

• Performs other duties as assigned.

On-Call Responsibilities

This position does not have any on-call responsibilities.

Supervisory Responsibilities

This position does not have any supervisory responsibilities.

Job Requirements

• May require the use of a personal cell phone. A cell phone stipend may be provided in accordance with organizational policy.

• Must be able to maintain all required professional certifications and continuing education requirements.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily, with or without reasonable accommodation. The requirements below are representative of the knowledge, skills, and abilities necessary for the position.

Being bilingual in another language, including American Sign Language (ASL), is an invaluable skill that enhances our ability to deliver culturally responsive care. We strongly encourage bilingual candidates to apply.

Relevant experience may include professional, educational, volunteer, and lived experience, or an equivalent combination, when applicable to the essential duties and qualifications of the position.

Education

• High school diploma or GED required.

• Completion of applicable coding, health information management, medical billing, or related postsecondary education or training preferred.

Experience

• Two or more years of related coding experience required, including experience with Medicare and/or commercial risk adjustment.

• Experience with Hierarchical Condition Category (HCC) coding and medical record documentation review.

• Experience interpreting medical records, coding guidelines, and supporting documentation to determine coding accuracy.

• Experience with risk adjustment auditing, medical record review, or related coding quality activities preferred.

Certificates, Licenses, and/or Registrations

• Certified Risk Adjustment Coder (CRC) certification required or must be obtained within 12 months of hire.

• Additional coding or auditing certifications, such as CPC, CCS, or CPMA, preferred.

Technical Skills

• Strong knowledge of Medicare and commercial risk adjustment methodologies, including HCC coding.

• Knowledge of CMS Risk Adjustment Data Validation (RADV) requirements and audit processes.

• Strong knowledge of ICD-10-CM coding guidelines and medical terminology.

• Knowledge of medical record documentation requirements and coding compliance standards.

• Knowledge of healthcare industry requirements and HIPAA regulations.

• Ability to review and interpret medical records, claims data, coding documentation, and audit findings.

• Ability to analyze data, identify trends and discrepancies, and develop meaningful recommendations.

• Ability to prepare clear, accurate, and actionable audit reports.

• Strong research skills and ability to interpret coding guidance, payer requirements, and CMS regulations.

• Strong written and verbal communication skills.

• Proficiency with Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel.

• Ability to learn and effectively use coding, auditing, claims, medical record, and other applicable software systems.

• Strong organizational and time-management skills with the ability to manage competing priorities and meet established deadlines.

• Ability to develop and deliver coding and documentation education to providers and internal stakeholders.

Interpersonal Skills

• Demonstrates strong organization, time management, and prioritization.

• Communicates professionally and constructively with providers, employees, leadership, and other stakeholders.

• Builds positive working relationships and collaborates effectively across departments and disciplines.

• Synthesizes information from multiple sources to identify and resolve problems.

• Demonstrates initiative, sound judgment, and appropriate independent decision-making.

• Adapts effectively to changing requirements, priorities, and regulatory guidance.

• Maintains a high degree of professionalism, confidentiality, and discretion.

• Approaches audit findings, education, and corrective feedback objectively and constructively.

• Demonstrates cultural awareness and provides respectful service to individuals from diverse backgrounds and experiences.

• Demonstrates a commitment to continuous learning and professional development.

Language Skills

Ability to read, analyze, and interpret professional journals, medical records, coding guidance, technical procedures, payer requirements, and governmental regulations. Ability to prepare reports, business correspondence, audit findings, and educational materials. Ability to effectively present information and respond to questions from providers, employees, leaders, and other stakeholders.

Mathematical Skills

Ability to perform calculations using whole numbers, fractions, decimals, rates, ratios, and percentages and to interpret data, charts, graphs, and other information used in coding, auditing, and performance reporting.

Computer Skills

This position requires proficiency with computer systems and applications used for medical record review, coding, auditing, data analysis, reporting, email communication, document creation, and other business functions. Must be able to learn and effectively use systems and technology required for the position.

Reasoning Ability

Ability to analyze medical records and supporting documentation, identify discrepancies, apply coding and regulatory guidance, and exercise sound judgment when evaluating complex coding and documentation issues. Ability to interpret instructions and requirements presented in written, oral, diagrammatic, or schedule-based formats.

Physical Demands & Work Environment

The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this position, the employee is regularly required to sit, use their hands, and communicate verbally. The employee is occasionally required to stand, walk, and reach with their hands and arms. The noise level in the work environment is typically moderate.

The physical demands and work environment described above are representative of those encountered while performing the essential duties of this position. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

Because this position involves access to patient records and protected health information, the employee must maintain the highest standards of confidentiality and privacy in accordance with HIPAA requirements and organizational policies.

Hybrid Work Requirement

This is a hybrid position based in Southern Oregon. Employees must reside in Southern Oregon and are required to work onsite a minimum of three days per week. Candidates outside the area must be willing to relocate to Southern Oregon at their own expense. This position is not eligible for fully remote work, and relocation assistance is not provided.

Company Overview

AllCare Health is incorporated as an Oregon Benefit Corporation and has maintained Certified B Corporation® status since 2017. As such, AllCare Health considers its impact on the community, society, and the environment in its business decisions.

AllCare Health headquarters are located in Grants Pass in Southern Oregon along the Rogue River, surrounded by mountains, forests, small farms, and scenic views. The region offers access to outdoor recreation, including rafting, fishing, hiking, biking, wineries, outdoor concerts, the Oregon Coast, redwood forests, and more.

The AllCare Health Family of Businesses Is Guided by Our Corporate Principles

Purpose | Working together with our communities to improve the health and well-being of everyone.

Values | Trust, Innovation, Relationships, and Voice.

Vision | Thriving, Inclusive, and Equitable communities.

Brand Promise | Changing Healthcare to Work for You.

AllCare Health is dedicated to building a diverse and authentic workplace centered on belonging and serving our growing community. If you are excited about this position but your experience does not align perfectly with every qualification listed, we encourage you to apply. You may be the right candidate for this role or another opportunity with AllCare Health.

If you need an accommodation, assistance with the application process, or this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.

All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disability status, genetic information, or any other status protected by applicable law.