Coding Educator​/Auditor - Remote

Now Hiring:
Remote CPMA Educator & Auditor

Summary:

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

Type of Opportunity:
Full time

Remote Workers New Mexico

Work Shift:

Days (United States of America)

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. Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area. 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;
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

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. RHIT, RHIA, CPC, CCS and a minimum of three (3) years experience in coding and/or auditing required. Audit experience preferred. Medical terminology, ICD-9, CPT-4 and HCPCS knowledge required.

Must have a proficient knowledge of Medicare, Medicaid, and other third party payer documentation, coding, and billing regulations for service lines(s) assigned.

Must possess excellent organizational and planning skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously.

Must possess computer…