We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The HCC Coding and Compliance Manager oversees the HCC Risk Adjustment department and projects. Ensures auditors comply with CMS rules and regulations, health plan audit requirements and coding guidelines.

Job Responsibilities/Duties

• Report to HCC Administrator / Director providers with documentation not meeting government guidelines identified through chart review process.
• Ensure that the HCC Risk Adjustment Coder/ Auditors maintain production levels to achieve company goals of 100% chart audit each year.
• Monitor and assign work flow between internal auditors.
• Oversee chart retrieval process and insure proper retrieval during the data year.
• Internal training of medical coder/auditors regarding medical coding and process of reporting.
• Monitor and Track all company programs i.e. AHA, IHA, SMA and any others implemented regarding the “process” created within the HCC Dept. to handle the program and assure all data is captured and processed correctly.
• Establish an interactive internal communication on documentation between internal auditors and providers.
• Monitor staff activities to ensure all tasks are compliant and following CMS guidelines and regulations.
• Implement and oversight staff auditing and perform spot checks monthly.

Qualifications

Minimum Education: Bachelor’s Degree or equivalent work experience.

Minimum Experience: Previous experience in HMO/health plan auditing and coalitions, experience with Excel and Access, coding experience, astute problem solving skills, ability to read and comprehend contracts and a Financial Responsibility Matrix, in depth knowledge of IDX and its various functions (i.e. referrals and claims), HMO referral experience, and certification in Medical Terminology. Knowledge of the CMS-HCC Risk Adjustment Methodology.

Req. Certification/Licensure: AHIMA or AAPC certified.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals, benefit eligible positions will receive:

• Company 401K
• Medical, dental, vision insurance
• Paid time-off
• Life insurance

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www.eeoc.gov/