ProFee Audit Specialist

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format.

Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care.

By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavant is committed to a culture of diversity, equity and inclusion, and our team reflects a wide spectrum of professional, educational and life experiences which drive our bold vision for healthcare.

As an Pro Fee Audit Specialist you will be instrumental in addressing consulting and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, interim coding management, and coding workflow operations reviews. In this role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare from your own workspace!

* For this position, we are seeking an auditor with a broad range of experience across multiple specialties, with strong expertise in neurosurgery and orthopedics. Experience in Interventional Radiology and HCC is a plus.

• Conduct inpatient coding audits on medical records, utilizing ICD-10-CM, CPT, and appropriate coding references for accurate DRG and APC assignment.

• Review non-CC/MCC records to assess proper coding or identify the need for additional documentation. Scrutinizes all HCPCS and CPT codes influencing APC assignment.

• Provide coder education through the auditing process.

• Prepare preliminary results for review by the facility or CCS HIM director.

• Review disagreements on APC/DRG changes with the appropriate manager.

• Prepare the final reports for the coding audit and actively participates in the resolution of audit findings.

• Provide coder education via email and/or conference calls, utilizing the audit spreadsheet findings and comments.

• Attend coding workshops as necessary.

• Stay current with regulatory changes.

• Organize and prioritize multiple cases concurrently to ensure departmental workflow and prompt case resolution.

• Demonstrate versatility and exceptional work across a wide range of coded services.

• Meet with client facility representatives to discuss issues and trends identified in audits.

• Develop and implement education for physicians, nursing, and other clinical staff to enhance documentation.

• Communicate effectively with co-workers, management, and hospital staff regarding clinical and reimbursement issues.

• Function in a professional, efficient, and positive manner.

• Adhere to the American Health Information Management Association’s code of ethics.

• Maintain a customer-service focus and exhibits professionalism, flexibility, dependability, a desire to learn, commitment to excellence, and commitment to the profession.

• Conduct audits on external coding staff as needed and provides reports to the manager as directed.

• Handle a high complexity of work functions and decision-making.

• Demonstrate strong organizational, teamwork, and leadership skills.

• 3-5 years experience auditing

• Associate or Bachelor's degree from an AHIMA-certified HIM or Nursing Program, or completion of a certificate program from AAPC with a preference for CCS

• Preferred: CCS, RHIT, or RHIA credentials.

• Recent experience in academic/level 1 trauma centers

• Experience coding and auditing inpatient and outpatient records for various facilities

• Track record of acceptable productivity standards

• Maintain 95% accuracy rate for APC assignment and 95% productivity rate

• Experience with various software including EMR, Encoder and Auditing software

• Benefits for…