Providence St. Joseph Health

Job Information

St. Joseph Health / Covenant Health Coding Quality Auditor - HSS HCC Coding in Anaheim, California

We are looking for a Coding Quality Auditor for the HSS HCC Coding Department at St. Joseph Heritage Healthcare.

Location: Anaheim, California

Schedule : Full Time - 80 Biweekly hours

Shift : 8 hour, Days

Job Summary:

The HCC Program Department at St. Joseph Heritage Health is responsible for the collection and reporting of supported diagnostic data to the Centers of Medicare and Medicaid Services (CMS) for risk adjustment purposes. This, in an organized effort to receive appropriate risk adjustment payments from CMS to support the costs associated with predicted healthcare needs for its Medicare Advantage (MA) enrollees which are based upon documented member health risk and other patient demographics.

The HCC Coding Quality Auditor is responsible for reviewing provider documentation of diagnostic data from each assigned MA enrollee's medical record to verify that all Medicare Advantage risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate. This data and other supplemental information necessary to meet reporting, compliance and educational objectives must be in strict adherence to St. Joseph Heritage Health's established HCC coding guidelines, Official ICD-9-CM and ICD-10-CM Guidelines for Coding and Reporting, AHA Coding Clinic, CMS, and other organizational policies and procedures. Complete and accurate risk adjustment reporting is required and is accomplished through the complete and accurate assignment of ICD-9-CM and ICD-10-CM codes corresponding to conditions that are considered part of CMS' Risk Adjustment Payment Models, and which are fully supported by each member's medical record.

Essential Functions:

  • Participates heavily in coding reviews and/or audits of medical records for risk adjustment reporting of all supported HCC conditions for submission to CMS.

  • Responsible for administrative duties related to planning, scheduling and conducting coding audits and maintaining records of provider audit results for HCC diagnosis codes.

  • Reviews patient records in accordance with current compliance policies and analyzes provider documentation to ensure compliance and identify opportunities for improvement.

  • Documents audit results in addition to resulting suggestions for coding and documentation improvement.

  • Ability to present audit findings to the Director of HCC Program, providers and other internal departments in an organized, professional and actionable format.

  • Understands “meaningful use” strategies and possesses an ability to synthesize coding data and present findings in a useful format.

  • Strong comfort level with educating and training peers and providers – on a one-to-one or group basis – in correct and efficient coding and documentation practices related to HCC; in addition to training coders and providers on how to utilize available tools to improve their knowledge and coding skills while maintaining compliance with all internal and external regulatory requirements for risk adjustment coding.

  • Possesses an optimistic “can-do” attitude and inspires that in others through steady and consistent example.

  • Creates and maintains positive relationships with peers, leadership, medical group providers, affiliate providers, office managers and all other associates inside and outside the organization.

  • Participates in developing, implementing and maintaining – as assigned:

• Programs for coding compliance monitoring.

• Criteria for benchmark comparisons.

• Organization’s policies and procedures.

• Providers clinical documentation improvement.

• Reports and applications supporting the HCC/Risk Adjustment Program.

  • Maintains up-to-date knowledge and coding credentials, remaining knowledgeable at all times of all current updates to governmental requirements and health plan requirements related to proper coding practices through continued education, research and reading resource material.


  • Demonstrates strong knowledge of correct application of M.E.A.T. concepts and ability to identify supported conditions and unsupported conditions with a high degree of accuracy.

  • Demonstrates thorough knowledge and proper understanding of advanced ICD-9-CM and ICD-10-CM coding rules and correct application in the context of HCC coding.

  • Demonstrates competent knowledge of Coding Clinic and CMS guidance as they relate to ICD-9 and ICD-10 coding and HCC coding.

  • Ability to synthesize complex, abstract and diverse information and provider documentation within the medical record, in its intended context.

  • Demonstrates strong attention to detail in both coding and all other job-related functions.

  • Ability to listen attentively and communicate clearly and concisely. Actively participates in meetings, as appropriate, using clear language and proper and professional grammar.

  • Demonstrates strong written communication skills. Demonstrates the ability to read and interpret written information and respond in proper grammatical sentences, using proper punctuation with context and clarity in a business-professional manner.

  • Strong reading comprehension skills; ability to correctly interpret context in provider documentation and other job-related training manuals and documents.

  • Ability to prioritize and plan work activities effectively and independently to accomplish work or meet deadlines in a timely manner; uses time efficiently.

  • Possesses a genuine interest in improving and promoting quality; demonstrates accuracy and thoroughness and assists others to achieve the same. Monitors own work to help ensure quality.

  • Always aspires to meet productivity standards and help improve them; completes work in timely manner; strives to increase productivity in a strategic and responsible manner.

  • Proficient typing skills and strong computer skills, including MS Office.

Minimum Position Qualifications:

Education : H.S. Diploma or GED

Experience :

  • 2 years HCC coding/auditing and diagnostic coding experience, or

  • 3 years ambulatory coding experience with 1 year HCC coding/auditing and diagnostic experience.

  • Experience in correct application of M.E.A.T. concepts.

Licenses and Certifications:

  • Current Coding Certification in one or more of the following: CPC, CPC-H, CPC-P, CCS, CCS-P, CCA, RHIA or RHIT.

  • Valid California driver’s license.

  • Automobile insurance for employee-owned vehicles.

Preferred Position Qualifications:

Experience :

  • 3 years HCC coding/auditing and diagnostic coding experience.

  • Experience in education/training HCC risk adjustment coding and documentation.

Mission Heritage Medical Group is one of California's most respected medical groups. With over 3,000 employees and 75 locations throughout California, including, Northern California, Orange County, High Desert and Los Angeles County, Mission Heritage Medical Group has been continually recognized as a leader in quality, customer service and information technology. This kind of success is the result of team work, a commitment to excellence and a strong adherence to the organization's mission, vision and values.Mission Heritage Medical Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Mission Heritage Medical Group complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Company: Heritage Healthcare

Category: Coding

Req ID: R327999