HCC QA Analyst in Orange at Prospect Medical Systems

Date Posted: 7/30/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

HCC QA Analyst

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.

Under minimal supervision, ensures accurate & appropriate documentation through chart audits as well as provider education and monitoring. Provides documentation coaching and feedback to HCC coding auditors and Prospect Medical network of providers based off of encounter audit findings. Monitors and tracks success of training and clinician feedback through encounter audits which ensure documentation meets requirements for diagnosis assignment, based on official ICD guidelines.

Job Responsibilities/Duties

  • Abstract pertinent information from assigned medical records using ICD-9-CM, ICD-10-CM, CPT and/or HCPCS codes.
  • Provide detailed comments/feedback on physician performance based on encounter audits.
  • Document detailed chart audit findings including all documentation errors; medical record errors; diagnosis errors as well as missed HCC opportunities.
  • Identify documentation training and HCC coding review training opportunities.
  • Encounter audits will be the primary monitoring tool used to identify operational and regulatory issues related to coding, documentation, and compliance requirements and to ensure complete and accurate data capture in compliance with Federal and State requirements.
  • Monitor corrective actions for audit review findings.
  • Serves as a local resource in meeting internal and external regulatory requirements (e.g., Centers for Medicare & Medicaid Service (CMS), National Committee for Quality Assurance (NCQA)).
  • Actively participate with local CMS (Center for Medicare/Medical Services) team to ensure local objectives are met and regional CMS compliance activities are supported.
  • Works with medical center leadership to provide confidential audits and feedback on an 'as needed' basis.
  • Assist in the identification of operational processes that hinder encounter data capture.
  • Prepare and/or perform auditing analysis and/or special projects as assigned.
  • Provide feedback on noncompliance issues detected through auditing.
  • Provide audit support to the HCC Risk Adjustment program specifically the yearly Wellness Visit Program.
  • Submit bi-weekly and monthly audit finding reports.


Minimum Education: A High School Diploma or Equivalent; BS/BA preferred.

Minimum Experience: Five or more (5+) years experience in healthcare setting related to HCC Risk Adjustment and/or chart auditing.

Req. Certification/Licensure: Must possess and maintain an AAPC or AHIMA certification — CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, RHIA.

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 you will receive:

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

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

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://www1.eeoc.gov/employers/poster.cfm