Quality Assurance Coder/Auditor

The Fountain Group LLC

Phoenix, AZ

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JOB DETAILS

SALARY

SKILLS

Analysis Skills, Anatomy, Auditing, Best Practices, Centers for Medicare and Medicaid Services (CMS), Certified Coding Specialist (CCS), Certified Nursing Assistant (CNA), Certified Professional Coder (CPC), Code Reviews, Content Management Systems (CMS), Documentation, Gap Closure, Health Plan, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), High School Diploma, ICD-10, Licensed Practical Nurse/Licensed Vocational Nurse, Managed Care, Medical Coding, Medical Records, Medical Terminology, Medicare, Microsoft Office, Outpatient Care, Quality Assurance, Quality Management, Quality Metrics, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Reporting Skills, Risk, Risk Management, Training/Teaching, Trend Analysis, Vendor/Supplier Evaluation

LOCATION

Phoenix, AZ

POSTED

24 days ago

The Fountain Group is a national staffing firm and are currently seeking a Quality Assurance Coder/Auditor for a prominent client of ours. This position is HYBRID located in Phoenix, AZ.

Details of the position are as follows:

Job Description:
Pay: $28.97/hour
Assignment Length: 6 Months with possibility to extend or convert
Schedule: Full-Time ONSITE ONCE A WEEK

Overview:
The Quality Assurance Coder/Auditor will support risk adjustment initiatives through medical record review, coding audits, provider education, and quality assurance activities. This individual will ensure accurate diagnosis coding, HCC capture, and compliance with CMS and Medicare Advantage requirements while helping improve documentation practices and coding accuracy.

Responsibilities:
• Review medical records and supporting documentation to determine coding accuracy, completeness, and compliance with CMS guidelines.
• Perform HCC coding reviews and abstract diagnosis codes to the highest level of specificity.
• Conduct quality assurance audits of supplemental data submissions and vendor coding activities.
• Identify coding trends, documentation gaps, and risk mitigation opportunities.
• Analyze medical records for valid encounters, provider signatures, and face-to-face visit requirements.
• Develop and deliver provider education regarding coding best practices, documentation requirements, and healthcare gap closure strategies.
• Track audit findings and prepare monthly reports with recommendations for management.
• Maintain current knowledge of Medicare Managed Care Manual Chapter 7, ICD-10 coding guidelines, and risk adjustment methodologies.
• Collaborate with internal stakeholders to improve coding accuracy and risk adjustment outcomes.

Qualifications:

Required:
• 5+ years of professional coding experience.
• 3+ years of HCC coding experience.
• Strong understanding of Risk Adjustment and Medicare Advantage programs.
• Knowledge of ICD-10 coding guidelines and HCC methodologies.
• Understanding of anatomy, pathophysiology, and medical terminology.
• Experience reviewing medical records and performing coding audits.
• Proficiency with Microsoft Office Suite.
• High School Diploma or GED.

Required Certifications (At least one of the Following):
• Certified Risk Adjustment Coder (CRC)
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Coding Specialist – Physician Based (CCS-P)

Preferred:
• Medicare Advantage health plan experience.
• HEDIS and/or CMS Stars experience.
• RADV audit experience.
• Clinical background (RN, LPN, MA, CNA).
• RHIT or RHIA credentials.
• CPMA or CDEO certification.

What We Look For:
• HCC coding and Risk Adjustment expertise.
• Medicare Advantage experience.
• HEDIS, Stars, or Quality Improvement experience.
• Strong medical record review and auditing background.
• CPC, CRC, COC, CCS-P, or CPMA certification.
• Experience working with major health plans such as Anthem, UnitedHealthcare, CVS/Aetna, Molina, Humana, Cigna, or WellCare.
• Highlight HCC coding experience with years of experience.
• Add Medicare Advantage and Risk Adjustment experience.
• Include HEDIS, NCQA, Stars, and RADV experience if applicable.
• Ensure coding certifications are prominently displayed.
• Quantify audit accuracy, productivity, and quality metrics when possible.
• Include provider education, training, or coding consultation experience.

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About the Company

The Fountain Group LLC

The Fountain Group provides Contingent Labor, Statement-of-Work, and Contingent-to-Permanent resources to clients with an internal/external Contingent Labor Managed Service Program or Clients without a program. The Fountain Group is committed to the belief that we all share in the responsibility to conduct our businesses in a socially and environmentally responsible manner. We base this on the premise that a company is much more than the products it offers. The effect a company has on the environment, the people and the communities it serves reflects the company’s dedication to being not only a good business, but to being a good corporate citizen. The Fountain Group believes the key to servicing a client is to identify the client demand precisely. Therefore, The Fountain Group focused its efforts on building and developing a process, which can identify an exact match for our client’s needs. Our process utilizes modern technology combined with 30+ years of Talent Acquisition experience to deliver Precision resources. Financial strength is prominent among The Fountain Group’s corporate values. The future of our business will be built on the innovation, compassion, outstanding services and technology, but a solid financial foundation is required to carry us forward to meet our business goal and support our long term vision.

COMPANY SIZE

500 to 999 employees

INDUSTRY

Staffing/Employment Agencies

WEBSITE

https://www.thefountaingroup.com/

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