Coding Compliance Auditor- Hospitals- Remote

As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities, and succeed in the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!

JOB SUMMARY

Develops inpatient coding educational courses and quizzes, including presenting live educational sessions, facilitating live Q&A calls, and recording audio for education. Researches complex inpatient coding issues. Conducts ad hoc audits of inpatient encounters to validate code assignment in compliance with the official coding guidelines as supported by clinical documentation in health record.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

• Develops inpatient coding education via PowerPoint and Articulate education software.
• Researches complex inpatient coding issues related to questions, inquiries, and investigations.
• Understands, interprets, and applies coding guidelines for risk-based audits and ad hoc audits. Audits inpatient diagnoses, procedural code assignments, and DRGs. Reviews accounts to validate submitted codes and abstracted data including, but not limited to ICD-10-CM codes and PCS codes, which impact reimbursement. .
• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating Coders, Auditors, Managers, and Directors throughout the organization.
• Identifies documentation issues (lacking documentation, missed physician queries, etc.) that impact coding accuracy. Clearly communicates (verbally and in written reports or summaries) opportunities for documentation improvement related to coding issues.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS, and other agency directives for ICD-10-CM and PCS coding. Completes online education courses and attends mandatory coding workshops and/or seminars (IPPS and ICD-10-CM/PCS updates) for inpatient coding. Reviews AHA quarterly coding update publications and biannual coding guideline updates. Attends all internal conference calls for Quarterly Coding Updates.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to consistently and accurately audit coding of inpatient encounters
• Ability to create clear and concise audit reports and maintain productivity standards
• Must successfully pass pre-hire coding assessment
• Knowledge of medical terminology, ICD-10-CM/PCS and DRG coding guidelines and methodologies
• Knowledge of disease pathophysiology and drug utilization
• Knowledge of DRG classification and reimbursement structures
• Must be detail oriented and have the ability to work independently
• Computer knowledge of MS Office
• Must display excellent interpersonal skills
• Ability to demonstrate initiative and discipline in time management and assignment completion
• Ability to work in a virtual setting under minimal supervision

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment.

EDUCATION / EXPERIENCE

• Associates degree in relevant field preferred or combination of equivalent of education and experience
• Five (5) years inpatient coding experience, outpatient coding experience a plus
• Five (5) years of experience in inpatient coding audit or quality review work, outpatient auditing experience a plus
• One (1) year of experience preparing and delivering education as it relates to audit findings or regulatory guidance to coders and auditors
• Three (3) years of Coding Compliance experience or the ability to demonstrate an advanced level of coding compliance knowledge

REQUIRED CERTIFICATIONS/LICENSURE

• AHIMA and/or AAPC Coding Credential, including RHIA, RHIT, CCS-P, CPC, and/or COC

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work in sitting position for extended periods
• Must be able to efficiently use computer, keyboard, and mouse to perform audit work assignments and answer telephone

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Home Office Work Environment

Compensation and Benefit Information

Compensation

• Pay: $30.60-$48.80 per hour. Compensation depends on location, qualifications, and experience.
• Conifer observed holidays receive time and a half.

Benefits

Conifer offers the following benefits, subject to employment status:

• Medical, dental, vision, disability, and life insurance
• Paid time off (vacation & sick leave) – min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match
• 10 paid holidays per year
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.

For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

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