QA Coding Auditor

Associate BPM III

 

Who We Are:

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.

We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.

Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

 

You Are:

UST HealthProof is seeking a highly energetic QA Coding Auditor. The QA Coding Auditor assists with conducting quality assurance audits for UST Healthproof certified coders working in the organization. This position performs validation audits on certified coders as part of the quality assurance program. This position also participates in vendor and client audits as per service level agreements.

 

The Opportunity:

The Opportunity:

·         Essential functions may vary depending on the specific focus of the role within the corporate risk adjustment team

·         Ensures compliance with all applicable Federal, State, and County laws and regulations related to coding and documentation guidelines for Medicare, ACA Commercial, and Medicaid Risk Adjustment.

·         Conducts QA audits for accuracy and completeness of ICD-10-CM diagnoses codes, queries, and clinical documentation suspect opportunities submitted by Healthproof certified coders.

·         Incorporates quality assurance information and maintains quality and productivity standards as outlined by QA Policies and Procedures for new hires and established coders.

·         Contributes to the quality improvement activities of the department and the organization including participating in internal department and client SLA audits.

·         Communicates QA coder audits effectively and professionally by preparing summary reports and conducts coaching as appropriate.

·         Reports trends and opportunities to improve coding and clinical documentation opportunities.

·         Makes corrections as needed to ensure accurate submission of HCC codes to clients. Independently organizes and prioritizes work to ensure completion of audit timeframes.

·         Ensure diagnosis codes, CDI queries and opportunities are supported by the documentation, client coding guidelines, and adhere with ICD-10CM Guidelines for Coding and Reporting

 

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

 

What You Need:

·         High School degree or equivalent.

·         Three (3) years of HCC risk adjustment coding experience OR Two (2) years HCC risk adjustment coding experience with One year CDI experience

·         Successful completion of a medical coding license. Acceptable licensed certifications include CPC, COC, or CRC from AAPC, or CCS or CCS-P from AHIMA.

·         Maintenance of continuing education/membership and active certification is required.

·         Prior risk adjustment audit experience preferred

·         Medicare, ACA Commercial, and Medicaid risk adjustment experience preferred

·         Experience and understanding of CMS Medicare, HHS Commercial, and Medicaid Risk

·         Advanced understanding of medical terminology, pharmacology, human anatomy/physiology, and concepts of disease pathology.

·         Extensive knowledge of ICD-10-CM coding guidelines and AHA Coding Clinic guidance. · Demonstrated ability to utilize a variety of electronic medical records systems.

·         Ability to work across multiple lines of business, coding models, electronic medical record systems, and directives accurately and efficiently while meeting established deadlines with minimal supervision.

·         Demonstrated ability to communicate clearly and effectively with a wide variety of individuals at all levels of the organization.

·         Strong time management skills.

·         Must possess a high degree of accuracy, completeness, and production efficiency

 

For this role, we value:

·         The ability to adapt quickly to a fast-paced environment

·         Excellent written and oral communication skills

·         Ability to collaborate with Customers teams and represent UST

 

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote

Compensation Range:  $56,000-64,000

 

 

Benefits

Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What We Believe

At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.

Guiding Principles

These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.

·         Simplicity

Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.

·         Integrity

Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.

·         People-Centricity

Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.

·         Leadership

Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.

Mission

A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.

Equal Employment Opportunity Statement

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

 

 

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