Remote Hybrid Pro Fee Auditor​/Educator

Job Details

Location Address: 9521 San Mateo NE, Albuquerque, NM

Compensation Pay Range: Minimum Offer $54,516.80 – Maximum Offer $83,262.40

Work Type: Remote Hybrid

Employment Type: Full time

Job Exempt: Yes

Job Location: Reverend Hugh Cooper Administrative Center

Work Shift: Days (United States of America)

Presbyterian is seeking a talented Hybrid Pro Fee Auditor/Educator to support the following responsibilities of the CDQA team: implementation of and compliance to enterprise-wide and department coding policies and procedures for PHS; compliance to all external regulatory agency coding rules and regulations; demonstrates high-level proficiency in performing and/or managing on-site internal audits or reviews to assess compliance/quality monitoring performed by PHS/PMG departments while serving as a resource on documentation, coding, billing, and coding compliance questions.

Works on special coding compliance related projects, develops and presents educational programs, disseminates information to PHS/PMG departments and develops educational tools used to maintain compliance with regulations. Provides support via auditing and training the enterprise-wide corrective action plans for coding, audit, physician and clinician personnel identified as low performers; performs medical record and billing reviews of denied and appealed claims.

Coordinates review and tracking of appealed claims including the communication process with affected payers; researches and interprets all regulatory agency regulations.

Some key responsibilities include:

• Liaison to the Manager, Information Services, Finance/Patient Financial Services, all hospitals, all PMG sites, PHP, Home Health, Albuquerque Ambulance, Compliance and all ancillary departments to address functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management and is responsible for maintaining accurate, complete, and timely documentation in either electronic or hard copy form.
• Adapt to frequently changing work priorities and schedules. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information concerning ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes.
• Research coding, billing and charging compliance issues, recommend and implement corrective action plans that assure compliance with regulatory agencies. Identify risks, develop and follow up on action plans, identify lost revenue opportunities and over payments due to coding or documentation errors, and provide compliance education.
• Assist in the creation of the CDQA Annual Audit Work‑plan using the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments.
• Exercise independent judgment in determining the reliability of data reviewed; recommend changes in existing practices to gain or maintain compliant behavior; stay informed on the healthcare industry business climate.
• Respond to inquiries and requests daily regarding coding and auditing issues and provide ad‑hoc analysis for all PHS management.

• High school diploma or GED required. Possess one of the following certifications: RHIT, RHIA, CPC, CCS.
• Minimum of three (3) years experience in coding and/or auditing.
• Audit experience preferred.
• Excellent written and verbal communication skills.
• Detail‑oriented and results‑oriented.
• Ability to work independently and make independent decisions.
• Medical terminology, ICD-9, CPT‑4 and HCPCS knowledge required.
• Proficient knowledge of Medicare, Medicaid, and other third‑party payer documentation, coding, and billing regulations for assigned service lines.
• Excellent organizational and planning skills, ability to prioritize multiple tasks and perform them accurately and simultaneously.
• Computer skills—Microsoft Word, PowerPoint, Excel, internet research for regulations.
• Communication skills to articulate complex regulatory information in layman’s terms.
• Professional presence characterized by honesty, integrity, and the ability to inspire and motivate others.

All benefits‑eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short‑term and long‑term disability, group term life insurance and other optional voluntary benefits.

Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well‑being. Earn gift cards and more by taking an active role in your personal well‑being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

AA/EOE/VET/DISABLED. PHS is a drug‑free and tobacco‑free employer with smoke‑free campuses.