Remote Profee Remote Auditor​/Educator

Location Address

Location Address: Remote Office, Santa Fe, NM 87501

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

Now Hiring:
Profee Remote Auditor/Educator

Build your Career. Make a Difference. Presbyterian is hiring a skilled Profee Remote Auditor/Educator to join our team. Type of Opportunity:
Full time. Job Exempt:
Yes. Job is based:
Remote Workers New Mexico.

Work Shift:

Days (United States of America).

With minimal supervision directly supports the following responsibilities of the Coding and documentation quality assurance (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 of 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; perform medical record and billing reviews of denied and appealed claims and takes appropriate action to ensure accurate payment of claims; coordinate review and tracking of appealed claims including the communication process with affected payers; research and interpret 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 in addressing functional coding, auditing, compliance and training issues and problems. Interacts with all levels of management. Responsible for maintaining accurate, complete and timely documentation in either electronic or hard copy form
• Must be able to adapt to frequently changing work priorities and schedules. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. This includes but is not limited to all ICD-9, ICD-10, CPT-4, HCPCS and APC updates and changes
• Researches coding, billing and charging compliance issues, recommends and implements corrective action plans that assure compliance with regulatory agencies where appropriate. Identifies risks, develops and follows up on action plans, identifies lost revenue opportunities and any over payments due to errors in coding and/or documentation, and provides compliance education
• Assists in the creation of the CDQA Annual Audit Work-plan by utilizing the OIG work plan, Medicare and Medicaid regulations, RAC and other audit agency focuses, as well as internal and external risk assessments
• Regularly exercises independent judgment in determining the reliability of data reviewed; recommends changes in existing practices to gain or maintain compliant behavior. Keeps actively informed on the business climate of the healthcare industry
• Responds to inquiries and requests daily regarding coding and auditing issues and problems and ad-hoc analysis for all PHS management
• Maintains up-to-date working knowledge of all PHS coding and auditing IT applications
• Gathers and analyzes information and provides recommendations to address and resolve business issues for a specific business group
• Conducts training classes in areas of coding, documentation and compliance for PHS/PMG personnel. This includes preparation of training materials, educational audits and answering specific situational questions, ICD-10 education and EPIC EMR documentation education to providers and clinical staff
• Conducts systematic focused internal audits via medical record and charge ticket review to insure correct coding, billing and charging as member of CDQA audit team
• Analyzes and summarizes data from medical record and account audits and communicate results and findings to management and compliance. Develops new methods and processes to improve coding efficiency and effectiveness
• Researches and investigates external and internal customer concerns regarding patient care and/or billing of patient care. Ensures that coding functions are performed in accordance with established quality and performance standards by monitoring system generated reports and quality audits
• Working hours may vary based on projects assigned
• Must be able to travel to all of the PHS/PMG sites (including overnight). Travel varies at certain times based on assignments

• High school diploma/GED required. Must possess at least one of the following…