Providence St. Joseph Health

Job Information

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

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

Location: Anaheim, California

Schedule : Full Time

Shift : Day

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.


• 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.

Position Requirements:

Education: H.S. Diploma or GED


  • 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.


• 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 Requirements:


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

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

St. Joseph Health - 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.St. Joseph Health - 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