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REMOTE Coding Compliance Auditor

  • Job ID 1905018282
  • Date posted 07/11/2019
  • Facility Conifer Health Solutions
Description:

JOB SUMMARY

Conducts risk-based coding quality audits and random quality audits of ambulatory surgery center (ASC)/same day surgery (SDS) outpatient encounters to validate code assignment is in compliance with the official coding guidelines as supported by clinical documentation in the health record. Validates abstracted data elements that are integral to appropriate payment methodology. Provides subject matter expertise to coding compliance concerns and questions.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

  • Understands, interprets and applies coding guidelines for coding audits.

  • Audits ambulatory surgery center/same day surgery encounters code assignments.

  • Review of medical records to determine coding accuracy of documented diagnoses and procedures.

  • Reviews claims to validate submitted codes and abstracted data including but not limited to ICD-10 CM codes, CPT codes, and Ambulatory Payment Classification (APC).

  • 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 CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (Outpatient Prospective Payment System (OPPS), ICD-10-CM and CPT updates) for outpatient coding. Reviews American Hospital Association (AHA) and CPT quarterly coding update publications. Attends internal conference calls for Quarterly Coding Updates.

FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense):

  • Provides input regarding departmental budget specific to area of responsibility.


Qualifications:
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 outpatient (ASC/SDS) encounters

  • Ability to create clear and concise audit reports and maintain productivity standards

  • Must successfully pass pre-hire coding assessment

  • Must successfully pass post-hire initial quality review (IQR)

  • Knowledge of medical terminology and ICD-10 CM/CPT-4 coding guidelines and methodologies

  • Knowledge of disease pathophysiology and drug utilization

  • Knowledge of APC, Outpatient Code Editor (OCE), National Correct Coding Initiative (NCCI) 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

EDUCATION / EXPERIENCE

Include minimum education, technical training, and/or experience preferred to perform the job.

  • Associates degree in relevant field preferred or combination of equivalent of education and experience

  • Three (3) years coding experience including but not limited to hospital outpatient encounters

  • One (1) year of experience in coding audit or quality review work including but not limited to hospital outpatient encounters.

  • Coding compliance experience
  • ASC/SDS coding/auditing experience
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
  • AHIMA and/or AAPC Coding Credential, CCS preferred
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

  • Ability to travel
  • Duties may require driving an automobile to off- site locations.

  • Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments

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 at 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: Conifer Health Solutions
Primary Location: Frisco, Texas
Other Locations: San Jose,Atlanta,Philadelphia,Houston,Denver,New York City,Fargo,Cleveland
Job Type: Full-time
Shift Type: Days