quality assurance coder/ auditor.

Market leading healthcare organization is looking for a Quality Assurance Coder/ Auditor to join our team in Phoenix, AZ.

This role is a 6 month contract with a strong perm possibility. Hybrid role, must be able to go into Phoenix office at least once a week, if not more.

Pay rate: $25 - $30.22 an hour

The Quality Assurance Coder/Auditor develops risk mitigation and provider education programs while ensuring accurate, compliant coding and documentation practices. This role reviews and analyzes medical records, performs risk adjustment and QA audits, identifies unsupported diagnoses, abstracts codes to the highest level of specificity, and provides education and feedback to providers, vendors, and stakeholders. Findings from audits, claims errors, and risk analyses are used to drive provider education, improve documentation quality, and support risk adjustment initiatives.

Essential Job Functions and Responsibilities:

-Comprehensive understanding of HCC coding rules, regulations, and methodologies.

-Review medical records and supporting documentation to determine completeness and accuracy.

-Identify and eliminate barriers to correct coding and recommend coding best practices and improvements.

-Determine valid encounters, including face-to-face visits, legibility requirements, and valid signatures according to Medicare Managed Care requirements.

-Track QA audits and provide monthly updates to vendors and management teams.

-Report findings and recommendations related to:

Closing healthcare gaps

Medical record documentation

Coding improvements

Additional educational training

-Maintain a QA audit accuracy goal of greater than 95%.

-Conduct medical record review and abstraction services accurately and efficiently.

-Develop an effective provider and coder education program supporting risk mitigation efforts.

-Travel to physician offices to conduct onsite educational training regarding:

Closing healthcare gaps

Accurate medical record documentation

Proper claims submission and coding

Track educational training sessions, including:

Date

Provider

Topic

Number of attendees

-Maintain current knowledge of:

Medicare Managed Care Manual, Chapter 7 - Risk Adjustment

Medicare outpatient billing systems and processes

-Maintain coding certifications and stay current with changes in risk adjustment methodologies.

-Work a full-time schedule of at least 40 hours per week, plus additional hours as needed to meet business requirements.

-Perform all other duties as assigned.

Required Qualifications

-5 years of professional coding experience.

-At least 3 years of HCC coding experience.

-Advanced knowledge of coding guidelines.

-5 years of Medicare Advantage health plan experience preferred.

-5 years of experience with HEDIS measures and/or the CMS Star Program preferred.

Required Certifications

One or more of the following:

-Certified Coding Specialist - Physician Based (CCS-P)

-Certified Risk Adjustment Coder (CRC)

-Certified Professional Coder (CPC)

-Certified Outpatient Coding (COC)


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.