BSWHP Risk Adjustment Auditor I

JOB SUMMARY for BSWHP (Baylor Scott & White Health Plan)

Accountable for reviewing member records to accurately maximize risk scoring in keeping with Baylor Scott and White Health strategies and processes for lines of business subject to risk adjustment.

SALARY RANGE

The pay range for this position is $26.27/hr (entry-level qualifications) - $39.41/hr (highly experienced). The specific rate will depend upon the successful candidate's specific qualifications and prior experience. 

ESSENTIAL FUNCTIONS OF THE ROLE

• Conducts provider audits and creates provider scorecards to offer feedback on Risk Adjustment Methodology
• Interprets health record documentation to code and abstracts diagnoses and/or procedures for inpatient, outpatient, and clinic cases
• Conducts focused HCC reviews on providers and clinics, tracks results and identifies trends and deficiencies for follow-up
• Researches complex coding HCC issues and keeps abreast of coding and compliance changes as communicated by CMS, HHS, AHA, AMA and the Federal Register, and sharing knowledge with co-workers, as directed
• Assists Risk Adjustment Auditor 2 or Manager with educator duties in the clinics on occasional based, as needed
• Protects data integrity and validity
• Maintains and respects patient confidentiality for accessing and disclosure of health information

KEY SUCCESS FACTORS

• Knowledge of ICD-10-CM and CPT coding conventions, and clinical documentation
• Knowledge of and compliance with standards of ethical coding as set forth by the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC)
• Knowledge of anatomy, physiology, pathological processes of disease, and medical terminology
• Critical thinking skills for chart review and abstraction
• Efficient Time Management skills
• Proficiency in use of Microsoft applications such as Word, Excel, and PowerPoint preferred

BENEFITS

Our competitive benefits package includes the following:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level

QUALIFICATIONS

• EDUCATION - Associate's or 2 years of work experience above the minimum qualification (with 2 years below, no degree = 4 years of experience needed to qualify)
• EXPERIENCE - 2 Years of Experience
  • Preferably in healthcare risk adjustments 

CERTIFICATION/LICENSE/REGISTRATION

 Must have one of the following:

• CCS - Certified Coding Specialist
• CCS-P - Certified Coding Specialist-Physician Based
• CPC - Certified Professional Coder
• RHIA - Reg Health Info Administrator
• RHIT - Reg Health Information Technician.